| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,396 |
3,386 |
$118K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,914 |
1,159 |
$114K |
| D0120 |
Periodic oral evaluation - established patient |
4,854 |
4,840 |
$95K |
| D1206 |
Topical application of fluoride varnish |
4,552 |
4,391 |
$80K |
| D1120 |
Prophylaxis - child |
2,422 |
2,420 |
$73K |
| D0274 |
Bitewings - four radiographic images |
2,608 |
2,596 |
$70K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,339 |
1,135 |
$57K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,149 |
775 |
$56K |
| D1351 |
Sealant - per tooth |
2,067 |
423 |
$52K |
| D0330 |
Panoramic radiographic image |
1,364 |
1,357 |
$48K |
| D0140 |
Limited oral evaluation - problem focused |
779 |
768 |
$40K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,299 |
1,293 |
$25K |
| D0272 |
Bitewings - two radiographic images |
1,078 |
1,077 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
1,897 |
1,862 |
$13K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
200 |
145 |
$13K |
| D2740 |
Crown - porcelain/ceramic |
24 |
12 |
$9K |
| D2954 |
|
111 |
86 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
506 |
452 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
64 |
43 |
$4K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
29 |
24 |
$3K |
| D2331 |
|
21 |
12 |
$1K |
| D2330 |
|
23 |
13 |
$1K |