| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,468 |
5,228 |
$223K |
| D0120 |
Periodic oral evaluation - established patient |
7,954 |
7,638 |
$186K |
| D0210 |
Intraoral - complete series of radiographic images |
3,092 |
2,947 |
$173K |
| D1120 |
Prophylaxis - child |
4,965 |
4,752 |
$160K |
| D1206 |
Topical application of fluoride varnish |
6,480 |
6,222 |
$131K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,601 |
809 |
$114K |
| D0274 |
Bitewings - four radiographic images |
3,350 |
3,204 |
$80K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,495 |
3,318 |
$69K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,100 |
1,972 |
$57K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
671 |
338 |
$49K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
812 |
443 |
$48K |
| D1351 |
Sealant - per tooth |
1,385 |
360 |
$39K |
| D2140 |
|
622 |
297 |
$37K |
| D9110 |
|
480 |
454 |
$23K |
| D0272 |
Bitewings - two radiographic images |
1,396 |
1,341 |
$22K |
| D2740 |
Crown - porcelain/ceramic |
40 |
27 |
$22K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
207 |
119 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
1,473 |
1,373 |
$17K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
346 |
315 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
386 |
187 |
$3K |
| D1999 |
|
106 |
84 |
$0.00 |