| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,364 |
1,339 |
$59K |
| D0274 |
Bitewings - four radiographic images |
1,941 |
1,917 |
$57K |
| D0330 |
Panoramic radiographic image |
1,158 |
1,147 |
$55K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
446 |
123 |
$52K |
| D7140 |
Extraction, erupted tooth or exposed root |
775 |
232 |
$52K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
417 |
285 |
$45K |
| D0120 |
Periodic oral evaluation - established patient |
2,116 |
2,056 |
$43K |
| D1120 |
Prophylaxis - child |
1,336 |
1,299 |
$39K |
| D1206 |
Topical application of fluoride varnish |
1,812 |
1,759 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
988 |
974 |
$28K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
147 |
97 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
1,335 |
1,291 |
$20K |
| D0140 |
Limited oral evaluation - problem focused |
567 |
561 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,382 |
666 |
$11K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
338 |
322 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
548 |
542 |
$8K |
| D1351 |
Sealant - per tooth |
51 |
14 |
$1K |
| D0601 |
|
121 |
121 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
17 |
12 |
$910.70 |
| D0602 |
|
44 |
44 |
$384.30 |