| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,655 |
3,550 |
$168K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,280 |
3,092 |
$142K |
| D0210 |
Intraoral - complete series of radiographic images |
3,134 |
2,435 |
$139K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,733 |
814 |
$124K |
| D0120 |
Periodic oral evaluation - established patient |
3,214 |
2,650 |
$71K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,239 |
270 |
$55K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
536 |
262 |
$43K |
| D1120 |
Prophylaxis - child |
909 |
861 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,186 |
1,117 |
$21K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
167 |
39 |
$11K |
| D0274 |
Bitewings - four radiographic images |
386 |
280 |
$8K |
| D2332 |
|
43 |
26 |
$5K |
| D0272 |
Bitewings - two radiographic images |
206 |
201 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
63 |
53 |
$2K |
| D0330 |
Panoramic radiographic image |
20 |
14 |
$456.40 |
| D0220 |
Intraoral - periapical first radiographic image |
16 |
12 |
$146.46 |