| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,876 |
1,784 |
$79K |
| D1120 |
Prophylaxis - child |
2,383 |
2,207 |
$69K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,063 |
2,032 |
$67K |
| D0272 |
Bitewings - two radiographic images |
3,499 |
3,287 |
$65K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,673 |
824 |
$65K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,107 |
2,929 |
$53K |
| D0120 |
Periodic oral evaluation - established patient |
2,385 |
2,165 |
$49K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
357 |
199 |
$41K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,137 |
538 |
$40K |
| D0220 |
Intraoral - periapical first radiographic image |
2,490 |
2,338 |
$34K |
| D0210 |
Intraoral - complete series of radiographic images |
575 |
535 |
$32K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,122 |
998 |
$25K |
| D1351 |
Sealant - per tooth |
1,026 |
386 |
$23K |
| D1206 |
Topical application of fluoride varnish |
1,093 |
1,026 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,861 |
1,666 |
$19K |
| D0330 |
Panoramic radiographic image |
824 |
766 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
452 |
427 |
$13K |
| D0603 |
|
1,976 |
1,949 |
$6K |
| D0274 |
Bitewings - four radiographic images |
316 |
311 |
$5K |
| D0602 |
|
1,518 |
1,498 |
$5K |
| D7240 |
Removal of impacted tooth - completely bony |
54 |
14 |
$4K |
| D2140 |
|
72 |
31 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
38 |
29 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
47 |
27 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
23 |
13 |
$2K |
| D0601 |
|
33 |
32 |
$70.18 |