| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,865 |
4,826 |
$231K |
| D0120 |
Periodic oral evaluation - established patient |
6,262 |
6,208 |
$189K |
| D1206 |
Topical application of fluoride varnish |
6,363 |
6,305 |
$166K |
| D0274 |
Bitewings - four radiographic images |
4,427 |
4,380 |
$154K |
| D0330 |
Panoramic radiographic image |
2,251 |
2,227 |
$148K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,729 |
1,088 |
$144K |
| D0140 |
Limited oral evaluation - problem focused |
3,488 |
3,354 |
$117K |
| D1120 |
Prophylaxis - child |
2,808 |
2,786 |
$92K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,358 |
785 |
$78K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,922 |
1,912 |
$63K |
| D7140 |
Extraction, erupted tooth or exposed root |
696 |
417 |
$61K |
| D1351 |
Sealant - per tooth |
1,804 |
477 |
$58K |
| D0272 |
Bitewings - two radiographic images |
1,491 |
1,482 |
$44K |
| D0220 |
Intraoral - periapical first radiographic image |
2,252 |
2,197 |
$29K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
295 |
191 |
$23K |
| D2140 |
|
169 |
102 |
$11K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
96 |
78 |
$11K |
| D2331 |
|
70 |
40 |
$7K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
54 |
27 |
$5K |
| D9110 |
|
68 |
67 |
$3K |
| D2160 |
|
13 |
12 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
12 |
12 |
$587.50 |
| D0270 |
|
34 |
30 |
$433.96 |
| D0230 |
Intraoral - periapical each additional radiographic image |
34 |
26 |
$341.14 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
17 |
14 |
$322.72 |
| D1999 |
|
660 |
571 |
$0.00 |
| D9995 |
|
111 |
110 |
$0.00 |