| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
20,360 |
19,541 |
$1.09M |
| D0120 |
Periodic oral evaluation - established patient |
22,592 |
22,232 |
$772K |
| D1206 |
Topical application of fluoride varnish |
23,609 |
23,268 |
$668K |
| D1354 |
|
17,417 |
5,660 |
$602K |
| D0274 |
Bitewings - four radiographic images |
13,342 |
13,151 |
$567K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,107 |
3,979 |
$492K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,438 |
3,998 |
$415K |
| D1120 |
Prophylaxis - child |
10,243 |
10,089 |
$392K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,265 |
1,917 |
$368K |
| D0330 |
Panoramic radiographic image |
4,534 |
4,454 |
$356K |
| D0140 |
Limited oral evaluation - problem focused |
7,702 |
7,351 |
$282K |
| D0230 |
Intraoral - periapical each additional radiographic image |
18,772 |
7,439 |
$226K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,500 |
5,390 |
$225K |
| D0220 |
Intraoral - periapical first radiographic image |
13,436 |
12,906 |
$219K |
| D9410 |
|
6,552 |
6,002 |
$192K |
| D1351 |
Sealant - per tooth |
5,670 |
2,063 |
$188K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,738 |
1,267 |
$175K |
| D2331 |
|
1,752 |
1,097 |
$164K |
| D1330 |
|
5,058 |
4,985 |
$140K |
| D2330 |
|
1,587 |
1,011 |
$114K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,703 |
3,971 |
$90K |
| D2140 |
|
963 |
689 |
$75K |
| D2160 |
|
569 |
478 |
$67K |
| D0272 |
Bitewings - two radiographic images |
1,900 |
1,862 |
$49K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
693 |
553 |
$45K |
| D2335 |
|
308 |
246 |
$42K |
| D2332 |
|
274 |
201 |
$38K |
| D0350 |
|
506 |
480 |
$34K |
| D5110 |
|
31 |
27 |
$31K |
| D9920 |
|
315 |
303 |
$21K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
104 |
72 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
60 |
60 |
$6K |
| D1310 |
|
168 |
168 |
$5K |
| D2161 |
|
30 |
28 |
$5K |
| D4355 |
|
44 |
40 |
$171.28 |
| D3120 |
|
112 |
86 |
$0.00 |
| D9985 |
|
24 |
24 |
$0.00 |
| D2394 |
|
16 |
15 |
$0.00 |
| D5992 |
|
124 |
83 |
$0.00 |
| D9996 |
|
16 |
16 |
$0.00 |