| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1354 |
|
23,566 |
4,082 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
765 |
364 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
1,960 |
1,904 |
$3K |
| D1120 |
Prophylaxis - child |
2,692 |
2,640 |
$2K |
| D1110 |
Prophylaxis - adult |
2,398 |
2,336 |
$2K |
| D1206 |
Topical application of fluoride varnish |
4,782 |
4,646 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
3,055 |
2,954 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
944 |
926 |
$1K |
| D0274 |
Bitewings - four radiographic images |
2,728 |
2,673 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
1,640 |
1,594 |
$747.95 |
| D1351 |
Sealant - per tooth |
2,156 |
503 |
$570.67 |
| D0330 |
Panoramic radiographic image |
202 |
196 |
$525.86 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
171 |
94 |
$323.22 |
| D0603 |
|
3,061 |
2,961 |
$222.20 |
| D0367 |
|
363 |
358 |
$142.00 |
| D0270 |
|
469 |
462 |
$138.45 |
| D0210 |
Intraoral - complete series of radiographic images |
159 |
155 |
$125.22 |
| D1330 |
|
8,813 |
8,385 |
$70.00 |
| D0601 |
|
2,103 |
2,031 |
$66.42 |
| D0602 |
|
1,845 |
1,781 |
$55.10 |
| D4910 |
|
65 |
63 |
$32.75 |
| D0230 |
Intraoral - periapical each additional radiographic image |
29 |
13 |
$30.00 |
| D1355 |
|
705 |
118 |
$4.00 |
| D0191 |
|
386 |
356 |
$0.00 |
| D1999 |
|
377 |
336 |
$0.00 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
14 |
12 |
$0.00 |
| D9910 |
|
13 |
12 |
$0.00 |
| D1310 |
|
3,364 |
3,256 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
15 |
13 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
75 |
74 |
$0.00 |