| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1354 |
|
6,745 |
611 |
$508K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,510 |
1,287 |
$243K |
| D1120 |
Prophylaxis - child |
3,851 |
3,847 |
$110K |
| D0120 |
Periodic oral evaluation - established patient |
4,549 |
4,542 |
$90K |
| D0220 |
Intraoral - periapical first radiographic image |
6,133 |
6,020 |
$89K |
| D1110 |
Prophylaxis - adult |
1,962 |
1,947 |
$85K |
| D0274 |
Bitewings - four radiographic images |
2,645 |
2,611 |
$77K |
| D0330 |
Panoramic radiographic image |
1,341 |
1,302 |
$65K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
512 |
178 |
$63K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,772 |
1,732 |
$53K |
| D1206 |
Topical application of fluoride varnish |
3,043 |
3,011 |
$50K |
| D0140 |
Limited oral evaluation - problem focused |
1,583 |
1,567 |
$46K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
369 |
194 |
$44K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,849 |
2,849 |
$40K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,133 |
4,306 |
$38K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
882 |
816 |
$23K |
| D7140 |
Extraction, erupted tooth or exposed root |
322 |
180 |
$21K |
| D0272 |
Bitewings - two radiographic images |
518 |
518 |
$9K |
| D1351 |
Sealant - per tooth |
336 |
99 |
$8K |
| D0350 |
|
261 |
259 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
113 |
79 |
$7K |
| D0602 |
|
233 |
227 |
$2K |
| D9310 |
|
12 |
12 |
$585.36 |