| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,895 |
5,714 |
$223K |
| D0230 |
Intraoral - periapical each additional radiographic image |
16,113 |
6,512 |
$200K |
| D0120 |
Periodic oral evaluation - established patient |
7,343 |
7,140 |
$182K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,208 |
862 |
$170K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,241 |
899 |
$133K |
| D0274 |
Bitewings - four radiographic images |
3,658 |
3,524 |
$113K |
| D0220 |
Intraoral - periapical first radiographic image |
7,229 |
6,950 |
$107K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,611 |
4,473 |
$76K |
| D0330 |
Panoramic radiographic image |
1,287 |
1,251 |
$74K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,359 |
1,155 |
$59K |
| D1120 |
Prophylaxis - child |
1,696 |
1,677 |
$46K |
| D2394 |
|
229 |
186 |
$36K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
787 |
755 |
$32K |
| D2332 |
|
228 |
149 |
$22K |
| D1351 |
Sealant - per tooth |
790 |
237 |
$22K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
169 |
79 |
$18K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
136 |
110 |
$17K |
| D0272 |
Bitewings - two radiographic images |
899 |
885 |
$16K |
| D7140 |
Extraction, erupted tooth or exposed root |
225 |
108 |
$14K |
| D4355 |
|
115 |
111 |
$7K |
| D2331 |
|
49 |
25 |
$4K |
| D1206 |
Topical application of fluoride varnish |
184 |
182 |
$3K |
| D2335 |
|
23 |
14 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
64 |
58 |
$2K |
| D2330 |
|
16 |
13 |
$981.24 |