| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
15,949 |
15,333 |
$834K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,818 |
5,206 |
$771K |
| D0120 |
Periodic oral evaluation - established patient |
22,956 |
22,143 |
$765K |
| D1206 |
Topical application of fluoride varnish |
18,817 |
18,374 |
$486K |
| D1120 |
Prophylaxis - child |
14,007 |
13,279 |
$478K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,892 |
4,268 |
$452K |
| D0274 |
Bitewings - four radiographic images |
10,289 |
10,171 |
$422K |
| D0330 |
Panoramic radiographic image |
3,606 |
3,561 |
$278K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,117 |
1,564 |
$267K |
| D0140 |
Limited oral evaluation - problem focused |
6,028 |
5,762 |
$214K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,395 |
1,543 |
$191K |
| D2331 |
|
1,891 |
1,179 |
$176K |
| D0272 |
Bitewings - two radiographic images |
5,026 |
4,954 |
$159K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,461 |
1,139 |
$154K |
| D9410 |
|
5,572 |
4,980 |
$149K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,406 |
3,302 |
$124K |
| D1330 |
|
3,248 |
3,223 |
$107K |
| D0350 |
|
1,055 |
1,035 |
$90K |
| D0220 |
Intraoral - periapical first radiographic image |
4,736 |
4,620 |
$74K |
| D1351 |
Sealant - per tooth |
3,030 |
980 |
$73K |
| D2160 |
|
506 |
386 |
$55K |
| D2330 |
|
850 |
542 |
$52K |
| D2140 |
|
570 |
397 |
$31K |
| D2335 |
|
140 |
109 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,452 |
791 |
$16K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
173 |
107 |
$13K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
811 |
665 |
$13K |
| D1354 |
|
399 |
118 |
$12K |
| D0145 |
Oral evaluation for a patient under three years of age |
260 |
259 |
$11K |
| D2332 |
|
115 |
79 |
$10K |
| D4355 |
|
49 |
49 |
$3K |
| D9920 |
|
47 |
45 |
$1K |
| D9996 |
|
151 |
150 |
$0.00 |
| D1999 |
|
17 |
15 |
$0.00 |
| D3120 |
|
29 |
24 |
$0.00 |