| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,386 |
4,294 |
$190K |
| D0272 |
Bitewings - two radiographic images |
6,490 |
6,355 |
$138K |
| D0120 |
Periodic oral evaluation - established patient |
5,973 |
5,864 |
$135K |
| D0220 |
Intraoral - periapical first radiographic image |
9,857 |
9,439 |
$127K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,065 |
8,115 |
$108K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,001 |
3,928 |
$74K |
| D1120 |
Prophylaxis - child |
2,043 |
2,015 |
$67K |
| D0140 |
Limited oral evaluation - problem focused |
1,442 |
1,416 |
$44K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
705 |
373 |
$43K |
| D1351 |
Sealant - per tooth |
1,598 |
203 |
$41K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
390 |
222 |
$31K |
| D0330 |
Panoramic radiographic image |
669 |
660 |
$20K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
51 |
48 |
$18K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
603 |
523 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
379 |
372 |
$11K |
| D2140 |
|
213 |
127 |
$8K |
| D0270 |
|
440 |
418 |
$6K |
| D2160 |
|
43 |
25 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
17 |
12 |
$1K |