| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,080 |
2,966 |
$69K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
962 |
689 |
$61K |
| D1120 |
Prophylaxis - child |
2,758 |
2,665 |
$56K |
| D1206 |
Topical application of fluoride varnish |
4,190 |
4,043 |
$54K |
| D1351 |
Sealant - per tooth |
2,987 |
886 |
$52K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
759 |
542 |
$38K |
| D1110 |
Prophylaxis - adult |
1,240 |
1,199 |
$34K |
| D0272 |
Bitewings - two radiographic images |
2,367 |
2,286 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
717 |
697 |
$26K |
| D0274 |
Bitewings - four radiographic images |
1,141 |
1,105 |
$23K |
| D0330 |
Panoramic radiographic image |
588 |
574 |
$18K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
234 |
166 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
419 |
396 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
94 |
74 |
$5K |
| D0145 |
Oral evaluation for a patient under three years of age |
160 |
143 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
179 |
171 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
410 |
403 |
$4K |
| D0350 |
|
94 |
94 |
$2K |
| D9996 |
|
107 |
107 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
14 |
13 |
$1K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
14 |
13 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
13 |
12 |
$284.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
18 |
18 |
$144.00 |