| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,319 |
1,243 |
$34K |
| D0120 |
Periodic oral evaluation - established patient |
1,541 |
1,457 |
$33K |
| D0274 |
Bitewings - four radiographic images |
1,072 |
1,023 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,580 |
1,840 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
2,179 |
2,049 |
$19K |
| D1206 |
Topical application of fluoride varnish |
1,261 |
1,216 |
$16K |
| D1120 |
Prophylaxis - child |
691 |
667 |
$13K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
212 |
129 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
198 |
126 |
$10K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
199 |
128 |
$9K |
| D0272 |
Bitewings - two radiographic images |
656 |
628 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
266 |
253 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
178 |
136 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
50 |
41 |
$2K |
| D2331 |
|
25 |
14 |
$2K |
| D2140 |
|
38 |
26 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
60 |
56 |
$1K |
| D1351 |
Sealant - per tooth |
52 |
12 |
$996.00 |
| D0140 |
Limited oral evaluation - problem focused |
31 |
31 |
$734.00 |
| D1999 |
|
468 |
420 |
$0.00 |