| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,315 |
4,243 |
$223K |
| D0330 |
Panoramic radiographic image |
3,563 |
3,502 |
$218K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,243 |
639 |
$136K |
| D0120 |
Periodic oral evaluation - established patient |
4,042 |
4,000 |
$121K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,088 |
1,627 |
$81K |
| D0272 |
Bitewings - two radiographic images |
3,510 |
3,445 |
$75K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,679 |
1,626 |
$74K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
530 |
273 |
$65K |
| D1351 |
Sealant - per tooth |
1,695 |
396 |
$58K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,688 |
2,638 |
$57K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
336 |
199 |
$48K |
| D1120 |
Prophylaxis - child |
1,181 |
1,159 |
$43K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
410 |
230 |
$31K |
| D2160 |
|
197 |
104 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
1,738 |
1,589 |
$25K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,056 |
747 |
$10K |
| D2140 |
|
67 |
40 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
79 |
79 |
$6K |