| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
3,395 |
3,394 |
$380K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,100 |
1,231 |
$270K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,797 |
2,538 |
$229K |
| D1110 |
Prophylaxis - adult |
3,304 |
3,300 |
$214K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,917 |
775 |
$186K |
| D1120 |
Prophylaxis - child |
1,748 |
1,747 |
$104K |
| D2394 |
|
305 |
179 |
$96K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,447 |
1,849 |
$77K |
| D2332 |
|
791 |
496 |
$53K |
| D2335 |
|
284 |
139 |
$38K |
| D0140 |
Limited oral evaluation - problem focused |
1,403 |
1,383 |
$33K |
| D4910 |
|
532 |
532 |
$32K |
| D0274 |
Bitewings - four radiographic images |
1,732 |
1,730 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
480 |
147 |
$10K |
| D4341 |
|
159 |
64 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,509 |
3,508 |
$8K |
| D9243 |
|
1,299 |
348 |
$3K |
| D4342 |
|
221 |
111 |
$3K |
| D1351 |
Sealant - per tooth |
4,657 |
1,033 |
$3K |
| D9239 |
|
298 |
292 |
$3K |
| D2330 |
|
103 |
64 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
2,996 |
2,992 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,124 |
2,872 |
$887.01 |
| D0272 |
Bitewings - two radiographic images |
811 |
810 |
$90.62 |
| D1206 |
Topical application of fluoride varnish |
2,732 |
2,728 |
$13.55 |
| D1208 |
Topical application of fluoride, excluding varnish |
2,027 |
2,025 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,779 |
3,077 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
4,285 |
4,242 |
$-75.17 |