| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,335 |
5,174 |
$193K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,083 |
1,445 |
$118K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,455 |
573 |
$117K |
| D0330 |
Panoramic radiographic image |
3,136 |
2,041 |
$105K |
| D0230 |
Intraoral - periapical each additional radiographic image |
22,394 |
5,270 |
$103K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,136 |
3,011 |
$86K |
| D0274 |
Bitewings - four radiographic images |
4,091 |
3,976 |
$75K |
| D0120 |
Periodic oral evaluation - established patient |
4,494 |
4,416 |
$68K |
| D9994 |
|
11,222 |
10,093 |
$67K |
| D0210 |
Intraoral - complete series of radiographic images |
3,050 |
1,537 |
$66K |
| D0220 |
Intraoral - periapical first radiographic image |
9,027 |
7,167 |
$60K |
| D9630 |
|
3,737 |
3,695 |
$58K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
980 |
691 |
$48K |
| D1206 |
Topical application of fluoride varnish |
2,145 |
2,120 |
$37K |
| D0140 |
Limited oral evaluation - problem focused |
2,064 |
1,720 |
$31K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
454 |
366 |
$29K |
| D1120 |
Prophylaxis - child |
752 |
749 |
$23K |
| D7140 |
Extraction, erupted tooth or exposed root |
555 |
141 |
$16K |
| D4341 |
|
142 |
70 |
$11K |
| D2740 |
Crown - porcelain/ceramic |
244 |
165 |
$11K |
| D2332 |
|
170 |
114 |
$10K |
| D4355 |
|
109 |
106 |
$8K |
| D9920 |
|
63 |
56 |
$5K |
| D9310 |
|
31 |
31 |
$3K |
| D2335 |
|
31 |
24 |
$2K |
| D9992 |
|
363 |
354 |
$2K |
| D1351 |
Sealant - per tooth |
57 |
12 |
$2K |
| D4346 |
|
31 |
28 |
$2K |
| D2331 |
|
54 |
39 |
$2K |
| D4910 |
|
12 |
12 |
$968.64 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
18 |
15 |
$607.32 |
| D2330 |
|
21 |
13 |
$0.00 |
| D2950 |
|
202 |
182 |
$0.00 |
| D1999 |
|
1,991 |
1,535 |
$0.00 |