| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
8,800 |
7,555 |
$327K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,688 |
2,288 |
$306K |
| D2740 |
Crown - porcelain/ceramic |
558 |
282 |
$215K |
| D1206 |
Topical application of fluoride varnish |
9,628 |
7,542 |
$166K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,802 |
1,614 |
$153K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,029 |
1,176 |
$146K |
| D0120 |
Periodic oral evaluation - established patient |
6,871 |
5,365 |
$133K |
| D0274 |
Bitewings - four radiographic images |
5,487 |
4,476 |
$118K |
| D9243 |
|
5,924 |
1,066 |
$113K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,258 |
3,389 |
$102K |
| D4910 |
|
2,456 |
1,239 |
$99K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,573 |
3,146 |
$88K |
| D0210 |
Intraoral - complete series of radiographic images |
1,997 |
1,564 |
$75K |
| D1120 |
Prophylaxis - child |
1,672 |
1,618 |
$52K |
| D2331 |
|
771 |
399 |
$48K |
| D9239 |
|
1,859 |
1,037 |
$35K |
| D0220 |
Intraoral - periapical first radiographic image |
3,308 |
2,602 |
$33K |
| D0330 |
Panoramic radiographic image |
1,146 |
1,094 |
$29K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,382 |
1,325 |
$27K |
| D0140 |
Limited oral evaluation - problem focused |
1,049 |
853 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,118 |
958 |
$17K |
| D2332 |
|
106 |
57 |
$8K |
| D4342 |
|
349 |
50 |
$7K |
| D2330 |
|
105 |
73 |
$5K |
| D2950 |
|
121 |
71 |
$3K |
| D0272 |
Bitewings - two radiographic images |
87 |
86 |
$1K |
| D9248 |
|
13 |
12 |
$954.47 |
| D1999 |
|
33 |
32 |
$0.00 |