| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,669 |
1,660 |
$107K |
| D0120 |
Periodic oral evaluation - established patient |
1,607 |
1,604 |
$95K |
| D1120 |
Prophylaxis - child |
1,997 |
1,980 |
$80K |
| D2791 |
|
116 |
87 |
$55K |
| D0210 |
Intraoral - complete series of radiographic images |
1,070 |
1,065 |
$51K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
624 |
347 |
$42K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,459 |
2,709 |
$32K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,188 |
2,168 |
$30K |
| D0274 |
Bitewings - four radiographic images |
873 |
872 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
1,119 |
1,116 |
$13K |
| D1320 |
|
798 |
798 |
$11K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
162 |
159 |
$6K |
| D9430 |
|
160 |
158 |
$5K |
| D4341 |
|
69 |
24 |
$5K |
| D1110 |
Prophylaxis - adult |
50 |
50 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
65 |
39 |
$4K |
| D1310 |
|
71 |
71 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
38 |
24 |
$3K |
| D9993 |
|
40 |
40 |
$3K |
| D4910 |
|
32 |
32 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
31 |
14 |
$2K |
| D1351 |
Sealant - per tooth |
96 |
29 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
21 |
12 |
$1K |
| D0270 |
|
14 |
14 |
$70.00 |