| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,946 |
4,867 |
$205K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,674 |
9,564 |
$194K |
| D0120 |
Periodic oral evaluation - established patient |
7,953 |
7,876 |
$186K |
| D1120 |
Prophylaxis - child |
4,904 |
4,870 |
$162K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,324 |
1,563 |
$141K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,868 |
1,308 |
$135K |
| D0210 |
Intraoral - complete series of radiographic images |
2,224 |
2,193 |
$130K |
| D1351 |
Sealant - per tooth |
3,879 |
1,555 |
$110K |
| D0220 |
Intraoral - periapical first radiographic image |
4,907 |
4,845 |
$61K |
| D0274 |
Bitewings - four radiographic images |
2,042 |
2,011 |
$55K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,942 |
1,851 |
$55K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,917 |
1,882 |
$53K |
| D0272 |
Bitewings - two radiographic images |
2,682 |
2,655 |
$47K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,727 |
4,454 |
$45K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
480 |
362 |
$35K |
| D7140 |
Extraction, erupted tooth or exposed root |
509 |
324 |
$30K |
| D2140 |
|
448 |
349 |
$27K |
| D0330 |
Panoramic radiographic image |
289 |
286 |
$13K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
121 |
89 |
$10K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
55 |
49 |
$6K |
| D2330 |
|
41 |
28 |
$2K |
| D2332 |
|
21 |
14 |
$2K |
| D9110 |
|
26 |
26 |
$975.00 |