| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,214 |
4,196 |
$247K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,142 |
1,079 |
$190K |
| D0120 |
Periodic oral evaluation - established patient |
5,198 |
5,184 |
$175K |
| D0274 |
Bitewings - four radiographic images |
3,276 |
3,267 |
$139K |
| D1120 |
Prophylaxis - child |
2,926 |
2,920 |
$114K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,331 |
2,319 |
$109K |
| D0220 |
Intraoral - periapical first radiographic image |
5,563 |
5,446 |
$103K |
| D0330 |
Panoramic radiographic image |
1,153 |
1,147 |
$96K |
| D1206 |
Topical application of fluoride varnish |
3,621 |
3,610 |
$94K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,226 |
4,428 |
$74K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
644 |
416 |
$48K |
| D0140 |
Limited oral evaluation - problem focused |
950 |
922 |
$41K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
383 |
188 |
$39K |
| D1330 |
|
1,955 |
1,939 |
$35K |
| D0272 |
Bitewings - two radiographic images |
652 |
649 |
$25K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
128 |
75 |
$19K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
758 |
676 |
$16K |
| D7140 |
Extraction, erupted tooth or exposed root |
131 |
48 |
$15K |
| D1351 |
Sealant - per tooth |
318 |
90 |
$9K |
| D1354 |
|
105 |
53 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
36 |
25 |
$3K |
| D2330 |
|
19 |
12 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
14 |
14 |
$1K |
| D1999 |
|
173 |
137 |
$0.00 |