| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
4,960 |
4,429 |
$291K |
| D1110 |
Prophylaxis - adult |
5,182 |
4,852 |
$214K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,726 |
1,401 |
$211K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,340 |
1,021 |
$208K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,204 |
1,663 |
$186K |
| D0120 |
Periodic oral evaluation - established patient |
7,876 |
7,344 |
$158K |
| D4346 |
|
982 |
899 |
$158K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,513 |
908 |
$143K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,896 |
3,642 |
$139K |
| D1351 |
Sealant - per tooth |
6,129 |
1,211 |
$134K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
705 |
386 |
$125K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,680 |
5,296 |
$99K |
| D0274 |
Bitewings - four radiographic images |
3,011 |
2,825 |
$89K |
| D2140 |
|
1,497 |
904 |
$68K |
| D1120 |
Prophylaxis - child |
2,378 |
2,227 |
$63K |
| D2160 |
|
835 |
527 |
$56K |
| D0140 |
Limited oral evaluation - problem focused |
1,531 |
1,404 |
$54K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
720 |
466 |
$44K |
| D0220 |
Intraoral - periapical first radiographic image |
4,003 |
3,655 |
$43K |
| D0330 |
Panoramic radiographic image |
1,307 |
1,208 |
$42K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,185 |
1,931 |
$29K |
| D2332 |
|
258 |
136 |
$29K |
| D2335 |
|
201 |
98 |
$26K |
| D0272 |
Bitewings - two radiographic images |
1,408 |
1,299 |
$21K |
| D2394 |
|
76 |
57 |
$9K |
| D1206 |
Topical application of fluoride varnish |
239 |
232 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
57 |
42 |
$2K |
| D1999 |
|
720 |
634 |
$0.00 |