| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,143 |
4,030 |
$170K |
| D0120 |
Periodic oral evaluation - established patient |
4,656 |
4,562 |
$109K |
| D7240 |
Removal of impacted tooth - completely bony |
426 |
126 |
$100K |
| D1206 |
Topical application of fluoride varnish |
3,509 |
3,419 |
$73K |
| D1120 |
Prophylaxis - child |
2,185 |
2,156 |
$70K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,753 |
2,704 |
$54K |
| D0274 |
Bitewings - four radiographic images |
1,978 |
1,922 |
$47K |
| D0330 |
Panoramic radiographic image |
1,225 |
1,196 |
$45K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
504 |
333 |
$35K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,170 |
1,142 |
$33K |
| D1351 |
Sealant - per tooth |
1,038 |
323 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
1,809 |
1,726 |
$20K |
| D9222 |
|
132 |
132 |
$12K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
410 |
376 |
$12K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
16 |
16 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
170 |
162 |
$10K |
| D0272 |
Bitewings - two radiographic images |
475 |
465 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
91 |
41 |
$6K |
| D1353 |
|
204 |
64 |
$5K |
| D9610 |
|
140 |
133 |
$3K |
| D2394 |
|
27 |
24 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
344 |
187 |
$2K |
| D4355 |
|
25 |
25 |
$2K |
| D9110 |
|
26 |
26 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
20 |
15 |
$970.25 |
| D0140 |
Limited oral evaluation - problem focused |
85 |
79 |
$829.60 |
| D9987 |
|
362 |
359 |
$0.00 |
| D9986 |
|
720 |
684 |
$0.00 |