| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
1,865 |
1,848 |
$55K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,384 |
1,094 |
$43K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,536 |
1,088 |
$36K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,029 |
2,990 |
$36K |
| D1110 |
Prophylaxis - adult |
1,421 |
1,416 |
$31K |
| D1120 |
Prophylaxis - child |
1,487 |
1,457 |
$28K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,433 |
2,334 |
$27K |
| D0330 |
Panoramic radiographic image |
1,112 |
1,088 |
$25K |
| D0120 |
Periodic oral evaluation - established patient |
2,259 |
1,934 |
$22K |
| D7140 |
Extraction, erupted tooth or exposed root |
814 |
565 |
$18K |
| D1351 |
Sealant - per tooth |
801 |
196 |
$9K |
| D0274 |
Bitewings - four radiographic images |
1,357 |
1,314 |
$8K |
| D1206 |
Topical application of fluoride varnish |
1,699 |
1,665 |
$7K |
| D1330 |
|
2,466 |
2,430 |
$6K |
| D0603 |
|
321 |
315 |
$6K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
56 |
54 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
575 |
556 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
3,301 |
3,050 |
$3K |
| D4346 |
|
74 |
74 |
$3K |
| V2025 |
Deluxe frame |
103 |
69 |
$3K |
| D0240 |
|
517 |
288 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
63 |
51 |
$2K |
| D0272 |
Bitewings - two radiographic images |
461 |
452 |
$1K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
13 |
13 |
$966.00 |
| D4355 |
|
25 |
25 |
$823.76 |
| D9995 |
|
20 |
17 |
$304.50 |
| D1208 |
Topical application of fluoride, excluding varnish |
300 |
298 |
$68.68 |
| V2020 |
Frames, purchases |
16 |
16 |
$68.00 |
| D0270 |
|
26 |
25 |
$30.06 |
| D0145 |
Oral evaluation for a patient under three years of age |
12 |
12 |
$23.00 |
| D1310 |
|
296 |
289 |
$0.00 |
| 92250 |
|
16 |
16 |
$0.00 |
| 1000F |
|
56 |
56 |
$0.00 |
| D0431 |
|
43 |
43 |
$0.00 |
| D0180 |
|
12 |
12 |
$0.00 |
| 92015 |
Determination of refractive state |
72 |
72 |
$0.00 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
14 |
14 |
$0.00 |