| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
7,027 |
5,120 |
$176K |
| D0120 |
Periodic oral evaluation - established patient |
6,749 |
4,958 |
$115K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,286 |
487 |
$107K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,128 |
635 |
$102K |
| D0274 |
Bitewings - four radiographic images |
4,819 |
3,425 |
$94K |
| D0140 |
Limited oral evaluation - problem focused |
3,620 |
2,587 |
$89K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,085 |
3,432 |
$74K |
| D0220 |
Intraoral - periapical first radiographic image |
7,062 |
5,034 |
$72K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
927 |
369 |
$70K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,197 |
1,601 |
$62K |
| D0330 |
Panoramic radiographic image |
1,675 |
1,330 |
$53K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
785 |
396 |
$47K |
| D4355 |
|
572 |
437 |
$27K |
| D7311 |
|
336 |
205 |
$23K |
| D1120 |
Prophylaxis - child |
816 |
611 |
$16K |
| D1206 |
Topical application of fluoride varnish |
1,336 |
900 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
740 |
696 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
132 |
71 |
$7K |
| D2332 |
|
46 |
31 |
$4K |
| D0160 |
|
64 |
51 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
70 |
56 |
$3K |
| D0272 |
Bitewings - two radiographic images |
144 |
123 |
$2K |
| D7510 |
|
25 |
17 |
$2K |
| D1351 |
Sealant - per tooth |
53 |
13 |
$1K |
| D0170 |
|
25 |
16 |
$428.75 |
| D0350 |
|
393 |
343 |
$225.00 |