| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,992 |
3,979 |
$330K |
| D0120 |
Periodic oral evaluation - established patient |
3,971 |
3,952 |
$176K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,737 |
756 |
$172K |
| D8670 |
Periodic orthodontic treatment visit |
497 |
497 |
$137K |
| D1206 |
Topical application of fluoride varnish |
3,316 |
3,303 |
$134K |
| D0274 |
Bitewings - four radiographic images |
2,116 |
2,113 |
$120K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
817 |
457 |
$110K |
| D0330 |
Panoramic radiographic image |
897 |
889 |
$99K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
591 |
316 |
$65K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
881 |
881 |
$52K |
| D2331 |
|
331 |
198 |
$52K |
| D1120 |
Prophylaxis - child |
884 |
881 |
$50K |
| D2160 |
|
354 |
204 |
$49K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
226 |
154 |
$38K |
| D2330 |
|
347 |
186 |
$37K |
| D2140 |
|
413 |
197 |
$35K |
| D0140 |
Limited oral evaluation - problem focused |
485 |
465 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
1,105 |
1,060 |
$28K |
| D7140 |
Extraction, erupted tooth or exposed root |
215 |
83 |
$28K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,034 |
542 |
$23K |
| D1330 |
|
526 |
523 |
$17K |
| D0350 |
|
134 |
133 |
$13K |
| D2335 |
|
37 |
27 |
$7K |
| D9944 |
|
13 |
13 |
$6K |
| D0272 |
Bitewings - two radiographic images |
112 |
112 |
$5K |
| D4910 |
|
36 |
36 |
$4K |
| D2161 |
|
16 |
12 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
28 |
25 |
$822.69 |
| D9985 |
|
45 |
42 |
$3.69 |