| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,927 |
3,818 |
$176K |
| D0210 |
Intraoral - complete series of radiographic images |
2,791 |
2,703 |
$169K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,920 |
1,033 |
$169K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,276 |
833 |
$145K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,041 |
2,943 |
$138K |
| D0120 |
Periodic oral evaluation - established patient |
4,533 |
4,449 |
$119K |
| D1120 |
Prophylaxis - child |
2,542 |
2,519 |
$85K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
724 |
426 |
$49K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,406 |
2,390 |
$46K |
| D0140 |
Limited oral evaluation - problem focused |
1,317 |
1,265 |
$46K |
| D0272 |
Bitewings - two radiographic images |
1,355 |
1,332 |
$26K |
| D0274 |
Bitewings - four radiographic images |
875 |
835 |
$23K |
| D7140 |
Extraction, erupted tooth or exposed root |
385 |
193 |
$21K |
| D1206 |
Topical application of fluoride varnish |
657 |
647 |
$15K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
127 |
76 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
974 |
940 |
$13K |
| D1351 |
Sealant - per tooth |
235 |
78 |
$7K |
| D0145 |
Oral evaluation for a patient under three years of age |
96 |
96 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
100 |
91 |
$3K |
| D0330 |
Panoramic radiographic image |
136 |
133 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
178 |
94 |
$2K |