| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7240 |
Removal of impacted tooth - completely bony |
2,667 |
857 |
$754K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,536 |
2,982 |
$538K |
| D0145 |
Oral evaluation for a patient under three years of age |
3,665 |
3,657 |
$516K |
| D1120 |
Prophylaxis - child |
10,199 |
10,139 |
$367K |
| D0120 |
Periodic oral evaluation - established patient |
12,037 |
11,967 |
$343K |
| D0230 |
Intraoral - periapical each additional radiographic image |
23,642 |
10,810 |
$265K |
| D1351 |
Sealant - per tooth |
7,468 |
2,097 |
$207K |
| D1208 |
Topical application of fluoride, excluding varnish |
13,441 |
13,362 |
$195K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,020 |
1,407 |
$157K |
| D1110 |
Prophylaxis - adult |
2,618 |
2,606 |
$141K |
| D0220 |
Intraoral - periapical first radiographic image |
11,469 |
11,360 |
$140K |
| D0210 |
Intraoral - complete series of radiographic images |
2,025 |
2,013 |
$138K |
| D0274 |
Bitewings - four radiographic images |
3,812 |
3,795 |
$129K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,743 |
4,653 |
$126K |
| D9248 |
|
1,019 |
1,016 |
$122K |
| D7230 |
|
441 |
210 |
$74K |
| D0272 |
Bitewings - two radiographic images |
2,750 |
2,732 |
$63K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,343 |
1,337 |
$46K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
265 |
192 |
$27K |
| D0140 |
Limited oral evaluation - problem focused |
413 |
412 |
$8K |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$81.53 |
| D0602 |
|
133 |
133 |
$0.00 |
| D0603 |
|
17,446 |
17,384 |
$0.00 |