| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,522 |
5,410 |
$190K |
| D1206 |
Topical application of fluoride varnish |
7,462 |
7,275 |
$149K |
| D0120 |
Periodic oral evaluation - established patient |
3,989 |
3,926 |
$90K |
| D9420 |
|
1,036 |
991 |
$74K |
| D0140 |
Limited oral evaluation - problem focused |
2,950 |
2,881 |
$70K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
728 |
496 |
$53K |
| D4341 |
|
543 |
157 |
$50K |
| D0210 |
Intraoral - complete series of radiographic images |
1,083 |
1,064 |
$45K |
| D1999 |
|
4,508 |
4,078 |
$43K |
| D0274 |
Bitewings - four radiographic images |
2,282 |
2,242 |
$42K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
756 |
470 |
$37K |
| D7140 |
Extraction, erupted tooth or exposed root |
462 |
125 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,345 |
1,325 |
$28K |
| D4910 |
|
749 |
703 |
$24K |
| D0330 |
Panoramic radiographic image |
709 |
701 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
1,645 |
1,539 |
$9K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
328 |
260 |
$8K |
| D2331 |
|
90 |
53 |
$5K |
| D2330 |
|
91 |
58 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,948 |
574 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
48 |
40 |
$4K |
| D4355 |
|
95 |
95 |
$4K |
| D1354 |
|
333 |
105 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
32 |
25 |
$2K |
| D1351 |
Sealant - per tooth |
72 |
12 |
$2K |
| D0180 |
|
27 |
27 |
$704.11 |
| D1120 |
Prophylaxis - child |
14 |
12 |
$314.24 |
| D9999 |
Unspecified adjunctive procedure, by report |
13 |
13 |
$159.17 |
| D9997 |
|
1,467 |
1,408 |
$0.00 |
| D3120 |
|
95 |
73 |
$0.00 |