| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,412 |
2,374 |
$200K |
| D0120 |
Periodic oral evaluation - established patient |
3,462 |
3,414 |
$188K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,871 |
2,818 |
$179K |
| D1120 |
Prophylaxis - child |
3,523 |
3,478 |
$134K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,965 |
5,888 |
$82K |
| D0210 |
Intraoral - complete series of radiographic images |
1,493 |
1,443 |
$69K |
| D9430 |
|
1,877 |
1,830 |
$59K |
| D0274 |
Bitewings - four radiographic images |
2,241 |
2,213 |
$47K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,816 |
3,170 |
$41K |
| D1310 |
|
808 |
802 |
$36K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
474 |
253 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
2,096 |
2,000 |
$25K |
| D9993 |
|
715 |
715 |
$22K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
172 |
104 |
$20K |
| D7140 |
Extraction, erupted tooth or exposed root |
243 |
114 |
$14K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
187 |
118 |
$12K |
| D0330 |
Panoramic radiographic image |
412 |
389 |
$12K |
| D0603 |
|
713 |
707 |
$10K |
| D1351 |
Sealant - per tooth |
345 |
81 |
$8K |
| D0272 |
Bitewings - two radiographic images |
656 |
655 |
$7K |
| D0350 |
|
839 |
466 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
171 |
159 |
$6K |
| D9110 |
|
86 |
83 |
$5K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
47 |
28 |
$3K |
| D4910 |
|
34 |
30 |
$3K |
| D2330 |
|
18 |
12 |
$1K |
| D1320 |
|
29 |
29 |
$457.50 |
| D0601 |
|
15 |
15 |
$225.00 |