| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,919 |
1,818 |
$63K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,382 |
703 |
$53K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
718 |
403 |
$33K |
| D0120 |
Periodic oral evaluation - established patient |
2,053 |
1,937 |
$31K |
| D0274 |
Bitewings - four radiographic images |
1,278 |
1,208 |
$30K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
794 |
726 |
$18K |
| D1206 |
Topical application of fluoride varnish |
1,599 |
1,474 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
1,841 |
1,617 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,663 |
1,277 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
471 |
436 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
298 |
206 |
$8K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
123 |
55 |
$8K |
| D1120 |
Prophylaxis - child |
555 |
499 |
$8K |
| D0330 |
Panoramic radiographic image |
243 |
217 |
$6K |
| D2332 |
|
62 |
30 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
509 |
408 |
$4K |
| D2394 |
|
42 |
27 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
100 |
84 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
36 |
13 |
$780.14 |
| D0272 |
Bitewings - two radiographic images |
86 |
76 |
$429.21 |
| D1999 |
|
737 |
637 |
$310.00 |
| D2331 |
|
18 |
13 |
$96.47 |