| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
34,709 |
32,432 |
$1.52M |
| D9410 |
|
34,423 |
31,352 |
$867K |
| D0120 |
Periodic oral evaluation - established patient |
28,757 |
28,172 |
$750K |
| D1206 |
Topical application of fluoride varnish |
23,702 |
23,298 |
$573K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,057 |
4,696 |
$517K |
| D0274 |
Bitewings - four radiographic images |
14,478 |
14,238 |
$489K |
| D0330 |
Panoramic radiographic image |
6,045 |
5,964 |
$399K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
7,516 |
4,429 |
$373K |
| D0140 |
Limited oral evaluation - problem focused |
10,378 |
9,877 |
$300K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,466 |
1,875 |
$276K |
| D1120 |
Prophylaxis - child |
8,886 |
8,751 |
$270K |
| D1354 |
|
8,455 |
3,106 |
$269K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
9,357 |
9,132 |
$261K |
| D0220 |
Intraoral - periapical first radiographic image |
14,741 |
14,212 |
$182K |
| D2331 |
|
2,238 |
1,508 |
$160K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,799 |
1,262 |
$152K |
| D1351 |
Sealant - per tooth |
6,384 |
1,944 |
$143K |
| D2330 |
|
1,883 |
1,255 |
$103K |
| D2335 |
|
963 |
723 |
$87K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,104 |
5,268 |
$82K |
| D2160 |
|
732 |
611 |
$77K |
| D2332 |
|
864 |
631 |
$71K |
| D5110 |
|
90 |
88 |
$62K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
656 |
450 |
$61K |
| D2140 |
|
860 |
610 |
$57K |
| D0272 |
Bitewings - two radiographic images |
2,674 |
2,622 |
$57K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
850 |
686 |
$49K |
| D5120 |
|
52 |
52 |
$38K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,383 |
1,993 |
$36K |
| D1330 |
|
1,144 |
1,126 |
$30K |
| D2161 |
|
74 |
68 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
225 |
154 |
$7K |
| D9920 |
|
198 |
144 |
$6K |
| D2394 |
|
95 |
86 |
$4K |
| D9110 |
|
19 |
19 |
$951.76 |
| D2940 |
|
12 |
12 |
$522.47 |
| D3120 |
|
227 |
190 |
$211.52 |
| D0270 |
|
16 |
15 |
$165.87 |
| D4355 |
|
34 |
26 |
$68.18 |
| D5992 |
|
2,301 |
1,871 |
$1.31 |
| D9995 |
|
39 |
39 |
$0.00 |