| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0240 |
|
9,028 |
5,971 |
$160K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,466 |
1,461 |
$158K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,412 |
958 |
$118K |
| D0330 |
Panoramic radiographic image |
2,397 |
2,329 |
$116K |
| D1120 |
Prophylaxis - child |
3,817 |
3,708 |
$106K |
| D1110 |
Prophylaxis - adult |
2,909 |
2,817 |
$105K |
| D0120 |
Periodic oral evaluation - established patient |
5,132 |
4,987 |
$95K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,662 |
3,120 |
$79K |
| D1206 |
Topical application of fluoride varnish |
2,897 |
2,803 |
$72K |
| D0274 |
Bitewings - four radiographic images |
2,463 |
2,389 |
$59K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,980 |
3,857 |
$58K |
| D0272 |
Bitewings - two radiographic images |
2,893 |
2,810 |
$51K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,464 |
1,414 |
$38K |
| D0140 |
Limited oral evaluation - problem focused |
1,086 |
1,051 |
$31K |
| D7140 |
Extraction, erupted tooth or exposed root |
141 |
87 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
466 |
438 |
$5K |
| D1351 |
Sealant - per tooth |
150 |
37 |
$4K |
| D2140 |
|
71 |
34 |
$3K |
| D0460 |
|
72 |
72 |
$2K |
| D2940 |
|
19 |
13 |
$517.00 |