| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
14,046 |
13,854 |
$672K |
| D0120 |
Periodic oral evaluation - established patient |
14,109 |
13,895 |
$417K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,070 |
2,732 |
$373K |
| D1206 |
Topical application of fluoride varnish |
15,897 |
15,633 |
$372K |
| D0274 |
Bitewings - four radiographic images |
10,977 |
10,800 |
$357K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,565 |
2,077 |
$352K |
| D0330 |
Panoramic radiographic image |
5,373 |
5,271 |
$318K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,614 |
2,194 |
$269K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,681 |
2,583 |
$264K |
| D0140 |
Limited oral evaluation - problem focused |
8,122 |
7,702 |
$254K |
| D1120 |
Prophylaxis - child |
5,304 |
5,185 |
$173K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,216 |
5,102 |
$157K |
| D1351 |
Sealant - per tooth |
7,753 |
1,252 |
$142K |
| D0220 |
Intraoral - periapical first radiographic image |
9,753 |
9,281 |
$126K |
| D2160 |
|
1,241 |
930 |
$123K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,059 |
678 |
$121K |
| D2140 |
|
2,317 |
1,325 |
$119K |
| D2330 |
|
1,519 |
852 |
$91K |
| D2331 |
|
1,160 |
704 |
$90K |
| D0272 |
Bitewings - two radiographic images |
2,400 |
2,319 |
$70K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,389 |
3,190 |
$61K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
715 |
536 |
$58K |
| D2332 |
|
607 |
395 |
$40K |
| D2720 |
|
39 |
12 |
$39K |
| D2335 |
|
400 |
279 |
$34K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,098 |
949 |
$26K |
| D1330 |
|
1,414 |
1,376 |
$24K |
| D0240 |
|
911 |
442 |
$24K |
| D2950 |
|
44 |
39 |
$10K |
| D2161 |
|
73 |
57 |
$10K |
| D4355 |
|
201 |
201 |
$715.61 |
| D9110 |
|
14 |
13 |
$526.11 |
| D9995 |
|
599 |
570 |
$0.00 |