| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,983 |
4,762 |
$265K |
| D2740 |
Crown - porcelain/ceramic |
437 |
224 |
$237K |
| D0274 |
Bitewings - four radiographic images |
3,607 |
3,369 |
$126K |
| D0120 |
Periodic oral evaluation - established patient |
3,974 |
3,705 |
$92K |
| D1120 |
Prophylaxis - child |
1,867 |
1,691 |
$86K |
| D2950 |
|
440 |
245 |
$58K |
| D0140 |
Limited oral evaluation - problem focused |
1,508 |
1,363 |
$55K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,268 |
1,129 |
$52K |
| D0220 |
Intraoral - periapical first radiographic image |
3,025 |
2,715 |
$44K |
| D1206 |
Topical application of fluoride varnish |
1,593 |
1,436 |
$39K |
| D0210 |
Intraoral - complete series of radiographic images |
484 |
470 |
$35K |
| D1208 |
Topical application of fluoride, excluding varnish |
886 |
858 |
$23K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
220 |
135 |
$19K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
224 |
27 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,643 |
1,178 |
$18K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
79 |
36 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
93 |
61 |
$6K |
| D0330 |
Panoramic radiographic image |
68 |
65 |
$5K |
| D1351 |
Sealant - per tooth |
102 |
28 |
$4K |
| D0272 |
Bitewings - two radiographic images |
155 |
141 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
35 |
26 |
$4K |
| D9222 |
|
29 |
27 |
$3K |
| D1999 |
|
140 |
125 |
$0.00 |
| D1330 |
|
12 |
12 |
$0.00 |