| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1354 |
|
13,514 |
2,507 |
$1.02M |
| D1110 |
Prophylaxis - adult |
7,261 |
6,871 |
$345K |
| D0120 |
Periodic oral evaluation - established patient |
9,983 |
9,506 |
$231K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,951 |
1,669 |
$220K |
| D4346 |
|
1,111 |
1,067 |
$205K |
| D1120 |
Prophylaxis - child |
5,386 |
5,100 |
$176K |
| D1206 |
Topical application of fluoride varnish |
8,344 |
7,916 |
$164K |
| D0274 |
Bitewings - four radiographic images |
4,772 |
4,479 |
$161K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,422 |
4,143 |
$161K |
| D1351 |
Sealant - per tooth |
6,225 |
1,021 |
$158K |
| D0230 |
Intraoral - periapical each additional radiographic image |
15,561 |
6,783 |
$154K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,244 |
828 |
$114K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,335 |
633 |
$109K |
| D0210 |
Intraoral - complete series of radiographic images |
3,317 |
2,740 |
$108K |
| D0330 |
Panoramic radiographic image |
2,426 |
2,207 |
$99K |
| D0220 |
Intraoral - periapical first radiographic image |
8,495 |
7,747 |
$86K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,390 |
833 |
$79K |
| D0140 |
Limited oral evaluation - problem focused |
1,450 |
1,328 |
$51K |
| D0272 |
Bitewings - two radiographic images |
1,680 |
1,601 |
$38K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
174 |
95 |
$28K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
879 |
786 |
$23K |
| D2932 |
|
90 |
68 |
$11K |
| D2332 |
|
83 |
53 |
$9K |
| D2335 |
|
40 |
26 |
$6K |
| D1999 |
|
498 |
410 |
$5K |
| D2331 |
|
39 |
24 |
$3K |
| D2394 |
|
17 |
13 |
$2K |
| D2330 |
|
22 |
12 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
42 |
41 |
$827.53 |