| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1354 |
|
6,045 |
1,945 |
$534K |
| D1351 |
Sealant - per tooth |
18,634 |
2,498 |
$381K |
| D4346 |
|
1,655 |
1,274 |
$261K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,541 |
5,859 |
$187K |
| D0274 |
Bitewings - four radiographic images |
7,023 |
5,505 |
$186K |
| D1110 |
Prophylaxis - adult |
4,746 |
3,836 |
$175K |
| D1120 |
Prophylaxis - child |
6,782 |
5,404 |
$163K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,549 |
1,160 |
$148K |
| D0120 |
Periodic oral evaluation - established patient |
7,326 |
5,973 |
$135K |
| D0230 |
Intraoral - periapical each additional radiographic image |
15,730 |
9,561 |
$109K |
| D0220 |
Intraoral - periapical first radiographic image |
13,333 |
10,297 |
$108K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,358 |
965 |
$94K |
| D1206 |
Topical application of fluoride varnish |
4,767 |
4,180 |
$90K |
| D0272 |
Bitewings - two radiographic images |
3,461 |
2,677 |
$58K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,171 |
2,948 |
$53K |
| D1355 |
|
745 |
267 |
$44K |
| D7140 |
Extraction, erupted tooth or exposed root |
689 |
200 |
$37K |
| D0140 |
Limited oral evaluation - problem focused |
1,185 |
955 |
$31K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
211 |
100 |
$27K |
| D0210 |
Intraoral - complete series of radiographic images |
526 |
386 |
$20K |
| D2335 |
|
20 |
13 |
$3K |
| D4910 |
|
31 |
25 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
86 |
84 |
$3K |
| D2330 |
|
32 |
12 |
$2K |
| D1999 |
|
3,049 |
1,874 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
23 |
13 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
30 |
29 |
$866.60 |
| D0330 |
Panoramic radiographic image |
13 |
12 |
$412.13 |
| D0603 |
|
717 |
686 |
$0.00 |
| D1330 |
|
65 |
52 |
$0.00 |