| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,087 |
2,087 |
$111K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
866 |
644 |
$67K |
| D0274 |
Bitewings - four radiographic images |
1,764 |
1,764 |
$65K |
| D0120 |
Periodic oral evaluation - established patient |
2,265 |
2,265 |
$61K |
| D1120 |
Prophylaxis - child |
1,457 |
1,457 |
$56K |
| D1206 |
Topical application of fluoride varnish |
1,783 |
1,783 |
$51K |
| D0330 |
Panoramic radiographic image |
841 |
841 |
$40K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
316 |
257 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
967 |
967 |
$27K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
178 |
177 |
$25K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
300 |
236 |
$23K |
| D2740 |
Crown - porcelain/ceramic |
35 |
33 |
$16K |
| D4910 |
|
283 |
283 |
$12K |
| D2160 |
|
106 |
86 |
$10K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
118 |
52 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
193 |
158 |
$10K |
| D4341 |
|
175 |
73 |
$9K |
| D2140 |
|
111 |
91 |
$6K |
| D2394 |
|
33 |
27 |
$4K |
| D2335 |
|
31 |
16 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
52 |
52 |
$4K |
| D2332 |
|
35 |
26 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
66 |
45 |
$3K |
| D0272 |
Bitewings - two radiographic images |
129 |
129 |
$3K |
| D4342 |
|
98 |
40 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
169 |
169 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
187 |
187 |
$2K |
| D1351 |
Sealant - per tooth |
66 |
13 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
87 |
85 |
$1K |