| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9910 |
|
2,906 |
668 |
$172K |
| D9430 |
|
3,679 |
2,793 |
$117K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,835 |
1,830 |
$108K |
| D1110 |
Prophylaxis - adult |
1,087 |
1,085 |
$87K |
| D0120 |
Periodic oral evaluation - established patient |
1,407 |
1,405 |
$63K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13,075 |
2,657 |
$53K |
| D0210 |
Intraoral - complete series of radiographic images |
1,083 |
1,082 |
$50K |
| D0340 |
|
924 |
924 |
$46K |
| D1120 |
Prophylaxis - child |
1,495 |
1,493 |
$43K |
| D0330 |
Panoramic radiographic image |
1,296 |
1,296 |
$39K |
| D0274 |
Bitewings - four radiographic images |
1,505 |
1,503 |
$31K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
161 |
79 |
$19K |
| D1206 |
Topical application of fluoride varnish |
1,297 |
1,297 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,534 |
1,530 |
$15K |
| D1351 |
Sealant - per tooth |
210 |
47 |
$5K |
| D4341 |
|
51 |
13 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
26 |
12 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
21 |
12 |
$1K |
| D0350 |
|
159 |
49 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
51 |
51 |
$606.05 |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$110.00 |
| D9993 |
|
12 |
12 |
$65.00 |
| D1310 |
|
12 |
12 |
$46.00 |