| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,609 |
4,586 |
$220K |
| D0120 |
Periodic oral evaluation - established patient |
4,746 |
4,727 |
$130K |
| D1120 |
Prophylaxis - child |
2,468 |
2,452 |
$122K |
| D0210 |
Intraoral - complete series of radiographic images |
2,222 |
2,218 |
$120K |
| D1206 |
Topical application of fluoride varnish |
3,085 |
3,069 |
$107K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,861 |
1,353 |
$105K |
| D0140 |
Limited oral evaluation - problem focused |
1,837 |
1,797 |
$85K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,979 |
2,955 |
$76K |
| D8670 |
Periodic orthodontic treatment visit |
799 |
737 |
$41K |
| D0330 |
Panoramic radiographic image |
2,749 |
2,732 |
$34K |
| D0274 |
Bitewings - four radiographic images |
3,773 |
3,744 |
$31K |
| D0220 |
Intraoral - periapical first radiographic image |
6,258 |
6,068 |
$25K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
530 |
447 |
$24K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
373 |
301 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,094 |
4,437 |
$21K |
| D1351 |
Sealant - per tooth |
777 |
122 |
$18K |
| D2954 |
|
116 |
102 |
$12K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
122 |
66 |
$10K |
| D4341 |
|
86 |
41 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
176 |
169 |
$3K |
| D0272 |
Bitewings - two radiographic images |
335 |
329 |
$2K |
| D0270 |
|
396 |
389 |
$1K |
| D9310 |
|
45 |
45 |
$660.00 |
| D1999 |
|
2,309 |
2,072 |
$0.00 |