| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,226 |
2,526 |
$206K |
| D2740 |
Crown - porcelain/ceramic |
380 |
264 |
$201K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,367 |
713 |
$180K |
| D0274 |
Bitewings - four radiographic images |
3,570 |
2,855 |
$160K |
| D0330 |
Panoramic radiographic image |
2,080 |
1,639 |
$153K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,518 |
2,387 |
$134K |
| D0140 |
Limited oral evaluation - problem focused |
2,013 |
1,711 |
$109K |
| D0220 |
Intraoral - periapical first radiographic image |
5,113 |
4,277 |
$101K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,005 |
3,270 |
$90K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,497 |
1,153 |
$72K |
| D0120 |
Periodic oral evaluation - established patient |
1,994 |
1,624 |
$71K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,100 |
881 |
$53K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
200 |
83 |
$47K |
| D2950 |
|
336 |
225 |
$46K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
241 |
117 |
$32K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
240 |
138 |
$27K |
| D4910 |
|
143 |
115 |
$11K |
| D2394 |
|
54 |
39 |
$11K |
| D1351 |
Sealant - per tooth |
189 |
27 |
$7K |
| D1120 |
Prophylaxis - child |
142 |
121 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
94 |
69 |
$5K |