| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,280 |
2,274 |
$109K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
805 |
496 |
$72K |
| D0120 |
Periodic oral evaluation - established patient |
2,448 |
2,444 |
$54K |
| D0274 |
Bitewings - four radiographic images |
2,010 |
2,007 |
$52K |
| D1120 |
Prophylaxis - child |
1,070 |
1,069 |
$37K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
881 |
875 |
$33K |
| D1206 |
Topical application of fluoride varnish |
1,979 |
1,976 |
$32K |
| D0220 |
Intraoral - periapical first radiographic image |
2,305 |
2,286 |
$28K |
| D0330 |
Panoramic radiographic image |
564 |
564 |
$27K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
357 |
259 |
$25K |
| D7140 |
Extraction, erupted tooth or exposed root |
288 |
138 |
$23K |
| D0140 |
Limited oral evaluation - problem focused |
493 |
492 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,690 |
1,294 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
542 |
542 |
$9K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
202 |
196 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
15 |
12 |
$2K |
| D0272 |
Bitewings - two radiographic images |
97 |
97 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
39 |
39 |
$2K |