| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,749 |
2,654 |
$141K |
| D0330 |
Panoramic radiographic image |
2,055 |
1,936 |
$115K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
910 |
561 |
$105K |
| D0120 |
Periodic oral evaluation - established patient |
2,976 |
2,915 |
$92K |
| D1120 |
Prophylaxis - child |
2,295 |
2,217 |
$86K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,968 |
1,817 |
$85K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,008 |
1,677 |
$78K |
| D2140 |
|
903 |
554 |
$77K |
| D0272 |
Bitewings - two radiographic images |
2,930 |
2,797 |
$66K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,872 |
2,774 |
$62K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
605 |
372 |
$54K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
227 |
149 |
$15K |
| D1206 |
Topical application of fluoride varnish |
490 |
484 |
$14K |
| D2160 |
|
92 |
69 |
$13K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
51 |
38 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
94 |
59 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
351 |
301 |
$4K |
| D3110 |
|
126 |
97 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
268 |
253 |
$4K |
| D1351 |
Sealant - per tooth |
76 |
27 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
25 |
25 |
$1K |