| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,836 |
3,722 |
$137K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,532 |
864 |
$128K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,725 |
1,082 |
$125K |
| D0120 |
Periodic oral evaluation - established patient |
6,688 |
6,464 |
$114K |
| D1120 |
Prophylaxis - child |
3,454 |
3,315 |
$90K |
| D1206 |
Topical application of fluoride varnish |
5,770 |
5,536 |
$88K |
| D0274 |
Bitewings - four radiographic images |
3,812 |
3,721 |
$83K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,350 |
875 |
$72K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,378 |
2,317 |
$58K |
| D4910 |
|
660 |
642 |
$38K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
384 |
284 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
2,494 |
2,336 |
$22K |
| D0272 |
Bitewings - two radiographic images |
1,153 |
1,117 |
$19K |
| D4341 |
|
209 |
81 |
$18K |
| D2331 |
|
199 |
146 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,859 |
1,100 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
319 |
312 |
$8K |
| D0603 |
|
1,089 |
1,083 |
$5K |
| D0330 |
Panoramic radiographic image |
255 |
243 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
109 |
108 |
$5K |
| D0145 |
Oral evaluation for a patient under three years of age |
105 |
105 |
$3K |
| D1351 |
Sealant - per tooth |
145 |
40 |
$2K |
| D0601 |
|
416 |
414 |
$2K |
| D2330 |
|
23 |
12 |
$1K |
| D2332 |
|
16 |
12 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
13 |
13 |
$171.08 |