| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9110 |
|
1,047 |
956 |
$56K |
| D1120 |
Prophylaxis - child |
1,386 |
1,349 |
$56K |
| D0120 |
Periodic oral evaluation - established patient |
1,704 |
1,643 |
$47K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,373 |
1,337 |
$35K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
449 |
335 |
$27K |
| D0274 |
Bitewings - four radiographic images |
988 |
950 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
2,091 |
1,987 |
$12K |
| D4341 |
|
57 |
30 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,694 |
1,622 |
$8K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
69 |
45 |
$7K |
| D1110 |
Prophylaxis - adult |
114 |
114 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
209 |
202 |
$4K |
| D0272 |
Bitewings - two radiographic images |
268 |
265 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
148 |
144 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
14 |
13 |
$555.30 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
16 |
13 |
$416.00 |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
12 |
$203.50 |
| D0270 |
|
33 |
33 |
$179.20 |