| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,317 |
2,179 |
$504K |
| D0145 |
Oral evaluation for a patient under three years of age |
3,162 |
3,090 |
$430K |
| D1351 |
Sealant - per tooth |
14,526 |
2,799 |
$372K |
| D0120 |
Periodic oral evaluation - established patient |
8,325 |
8,098 |
$229K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,003 |
1,551 |
$220K |
| D1120 |
Prophylaxis - child |
6,049 |
5,890 |
$210K |
| D0230 |
Intraoral - periapical each additional radiographic image |
17,659 |
8,361 |
$187K |
| D1110 |
Prophylaxis - adult |
3,326 |
3,232 |
$158K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,967 |
8,714 |
$125K |
| D0274 |
Bitewings - four radiographic images |
3,458 |
3,361 |
$111K |
| D0220 |
Intraoral - periapical first radiographic image |
9,105 |
8,808 |
$106K |
| D7240 |
Removal of impacted tooth - completely bony |
252 |
79 |
$70K |
| D0272 |
Bitewings - two radiographic images |
2,850 |
2,774 |
$59K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
757 |
711 |
$24K |
| D2332 |
|
133 |
87 |
$16K |
| D0330 |
Panoramic radiographic image |
462 |
439 |
$12K |
| D2335 |
|
57 |
42 |
$9K |
| D9222 |
|
155 |
145 |
$8K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
178 |
118 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
343 |
333 |
$6K |
| D9243 |
|
138 |
53 |
$4K |
| D9239 |
|
54 |
53 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
42 |
42 |
$3K |
| D2330 |
|
17 |
13 |
$1K |
| D9610 |
|
88 |
75 |
$1K |
| D0160 |
|
87 |
77 |
$1K |
| D1206 |
Topical application of fluoride varnish |
73 |
73 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
27 |
25 |
$650.64 |
| D0603 |
|
12,336 |
12,062 |
$0.00 |