| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,055 |
3,004 |
$125K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,899 |
617 |
$125K |
| D0274 |
Bitewings - four radiographic images |
4,281 |
4,190 |
$123K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,422 |
3,340 |
$118K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,295 |
844 |
$94K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,788 |
4,308 |
$76K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,966 |
3,896 |
$71K |
| D0220 |
Intraoral - periapical first radiographic image |
5,207 |
5,057 |
$58K |
| D1120 |
Prophylaxis - child |
1,616 |
1,588 |
$52K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
682 |
458 |
$38K |
| D0140 |
Limited oral evaluation - problem focused |
1,282 |
1,238 |
$37K |
| D0330 |
Panoramic radiographic image |
832 |
806 |
$29K |
| D0210 |
Intraoral - complete series of radiographic images |
401 |
399 |
$24K |
| D0120 |
Periodic oral evaluation - established patient |
1,020 |
1,003 |
$23K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
244 |
182 |
$22K |
| D4346 |
|
129 |
124 |
$15K |
| D1351 |
Sealant - per tooth |
611 |
145 |
$13K |
| D2335 |
|
25 |
13 |
$3K |
| D1206 |
Topical application of fluoride varnish |
162 |
160 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
12 |
12 |
$333.49 |