| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,072 |
3,058 |
$93K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
873 |
575 |
$80K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
970 |
717 |
$78K |
| D1120 |
Prophylaxis - child |
1,699 |
1,693 |
$69K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,362 |
445 |
$66K |
| D0210 |
Intraoral - complete series of radiographic images |
1,249 |
1,242 |
$66K |
| D0274 |
Bitewings - four radiographic images |
2,126 |
2,124 |
$63K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
130 |
126 |
$60K |
| D7250 |
|
396 |
290 |
$58K |
| D0120 |
Periodic oral evaluation - established patient |
2,389 |
2,383 |
$49K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,203 |
1,046 |
$42K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,583 |
1,578 |
$42K |
| D0140 |
Limited oral evaluation - problem focused |
1,482 |
1,388 |
$35K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
432 |
247 |
$30K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
304 |
249 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
1,574 |
1,481 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,043 |
570 |
$9K |
| D0272 |
Bitewings - two radiographic images |
283 |
282 |
$7K |
| D2140 |
|
116 |
65 |
$6K |
| D1206 |
Topical application of fluoride varnish |
375 |
374 |
$5K |
| D2791 |
|
12 |
12 |
$5K |
| D2954 |
|
34 |
28 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
49 |
44 |
$4K |
| D2332 |
|
37 |
26 |
$3K |
| D0330 |
Panoramic radiographic image |
31 |
31 |
$2K |
| D1351 |
Sealant - per tooth |
51 |
15 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
27 |
26 |
$2K |
| D2331 |
|
18 |
15 |
$1K |
| D2330 |
|
17 |
13 |
$884.00 |
| D0160 |
|
13 |
13 |
$384.00 |