| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4342 |
|
11,341 |
2,917 |
$868K |
| D1110 |
Prophylaxis - adult |
5,804 |
5,633 |
$470K |
| D0120 |
Periodic oral evaluation - established patient |
7,675 |
7,482 |
$280K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
549 |
452 |
$246K |
| D4346 |
|
1,240 |
1,218 |
$124K |
| D1206 |
Topical application of fluoride varnish |
3,737 |
3,629 |
$112K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,311 |
3,221 |
$85K |
| D9222 |
|
462 |
384 |
$51K |
| D0330 |
Panoramic radiographic image |
575 |
565 |
$46K |
| D2750 |
|
89 |
28 |
$42K |
| D4341 |
|
249 |
54 |
$39K |
| D0220 |
Intraoral - periapical first radiographic image |
1,981 |
1,747 |
$39K |
| D0274 |
Bitewings - four radiographic images |
431 |
419 |
$20K |
| D0350 |
|
329 |
314 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
819 |
383 |
$16K |
| D4355 |
|
125 |
124 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
190 |
184 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
163 |
150 |
$8K |
| D0180 |
|
96 |
95 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
32 |
31 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
20 |
12 |
$3K |
| D4910 |
|
27 |
27 |
$2K |