| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,511 |
2,388 |
$101K |
| D0120 |
Periodic oral evaluation - established patient |
3,388 |
3,247 |
$78K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,143 |
642 |
$75K |
| D1206 |
Topical application of fluoride varnish |
3,535 |
3,351 |
$70K |
| D1120 |
Prophylaxis - child |
1,305 |
1,227 |
$40K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
453 |
309 |
$26K |
| D0210 |
Intraoral - complete series of radiographic images |
471 |
441 |
$24K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
936 |
790 |
$24K |
| D0274 |
Bitewings - four radiographic images |
883 |
832 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
836 |
772 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
991 |
959 |
$19K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
245 |
157 |
$18K |
| D1353 |
|
611 |
153 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
1,433 |
1,347 |
$17K |
| D1351 |
Sealant - per tooth |
555 |
151 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,527 |
966 |
$13K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
101 |
12 |
$5K |
| D0330 |
Panoramic radiographic image |
118 |
112 |
$5K |
| D0272 |
Bitewings - two radiographic images |
123 |
120 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
51 |
43 |
$902.80 |
| D1999 |
|
21 |
20 |
$0.00 |