| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2722 |
|
563 |
242 |
$601K |
| D0330 |
Panoramic radiographic image |
7,770 |
7,640 |
$539K |
| D1110 |
Prophylaxis - adult |
9,085 |
8,922 |
$501K |
| D0274 |
Bitewings - four radiographic images |
12,458 |
12,253 |
$495K |
| D0120 |
Periodic oral evaluation - established patient |
11,880 |
11,727 |
$419K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,204 |
2,288 |
$347K |
| D1206 |
Topical application of fluoride varnish |
12,304 |
12,090 |
$340K |
| D0140 |
Limited oral evaluation - problem focused |
7,285 |
6,981 |
$283K |
| D1120 |
Prophylaxis - child |
6,172 |
6,123 |
$242K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,275 |
1,822 |
$214K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,606 |
522 |
$211K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,541 |
3,450 |
$111K |
| D1330 |
|
6,027 |
5,892 |
$99K |
| D0220 |
Intraoral - periapical first radiographic image |
6,190 |
5,365 |
$90K |
| D7140 |
Extraction, erupted tooth or exposed root |
866 |
352 |
$84K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,066 |
646 |
$83K |
| D1351 |
Sealant - per tooth |
2,231 |
614 |
$81K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
530 |
394 |
$57K |
| D2950 |
|
255 |
156 |
$49K |
| D2160 |
|
437 |
302 |
$47K |
| D2335 |
|
274 |
165 |
$34K |
| D1354 |
|
1,632 |
461 |
$33K |
| D2331 |
|
305 |
205 |
$29K |
| D2140 |
|
457 |
296 |
$28K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,714 |
1,643 |
$26K |
| D4910 |
|
238 |
236 |
$19K |
| D4341 |
|
74 |
29 |
$15K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
562 |
517 |
$12K |
| D2332 |
|
98 |
51 |
$10K |
| D0272 |
Bitewings - two radiographic images |
161 |
159 |
$6K |
| D2330 |
|
77 |
45 |
$5K |
| D2394 |
|
27 |
24 |
$4K |
| D9110 |
|
74 |
67 |
$4K |
| D4355 |
|
29 |
27 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
12 |
12 |
$495.18 |
| D0270 |
|
35 |
33 |
$369.81 |
| D1208 |
Topical application of fluoride, excluding varnish |
15 |
15 |
$341.46 |