| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,951 |
2,865 |
$122K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,140 |
5,011 |
$105K |
| D1120 |
Prophylaxis - child |
3,182 |
3,121 |
$104K |
| D0120 |
Periodic oral evaluation - established patient |
4,065 |
3,980 |
$95K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,079 |
798 |
$73K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,442 |
2,171 |
$69K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
745 |
544 |
$44K |
| D0210 |
Intraoral - complete series of radiographic images |
720 |
684 |
$42K |
| D0274 |
Bitewings - four radiographic images |
1,226 |
1,205 |
$33K |
| D0220 |
Intraoral - periapical first radiographic image |
1,828 |
1,743 |
$22K |
| D0272 |
Bitewings - two radiographic images |
1,075 |
1,061 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
584 |
558 |
$16K |
| D1351 |
Sealant - per tooth |
385 |
118 |
$12K |
| D1206 |
Topical application of fluoride varnish |
375 |
370 |
$8K |
| D9110 |
|
104 |
102 |
$5K |
| D0330 |
Panoramic radiographic image |
62 |
62 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
185 |
115 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
33 |
25 |
$2K |
| D2331 |
|
16 |
12 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
13 |
13 |
$292.80 |