| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,171 |
1,136 |
$38K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
649 |
397 |
$33K |
| D7140 |
Extraction, erupted tooth or exposed root |
539 |
188 |
$31K |
| D0120 |
Periodic oral evaluation - established patient |
1,540 |
1,492 |
$25K |
| D0274 |
Bitewings - four radiographic images |
1,194 |
1,150 |
$22K |
| D0140 |
Limited oral evaluation - problem focused |
948 |
886 |
$19K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,209 |
1,172 |
$17K |
| D1120 |
Prophylaxis - child |
857 |
829 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
305 |
204 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
458 |
440 |
$11K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
176 |
125 |
$11K |
| D0330 |
Panoramic radiographic image |
179 |
173 |
$7K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
20 |
18 |
$6K |
| D0350 |
|
221 |
186 |
$6K |
| D0272 |
Bitewings - two radiographic images |
521 |
510 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
927 |
877 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
41 |
28 |
$2K |
| D2394 |
|
29 |
26 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
32 |
30 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
92 |
76 |
$2K |
| D2332 |
|
21 |
13 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
55 |
42 |
$275.00 |