| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
7,025 |
6,658 |
$315K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,232 |
1,395 |
$223K |
| D0120 |
Periodic oral evaluation - established patient |
9,168 |
8,650 |
$192K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,187 |
1,125 |
$185K |
| D0210 |
Intraoral - complete series of radiographic images |
2,629 |
2,433 |
$164K |
| D0274 |
Bitewings - four radiographic images |
3,138 |
2,951 |
$102K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,773 |
3,527 |
$65K |
| D0140 |
Limited oral evaluation - problem focused |
2,051 |
1,889 |
$63K |
| D1120 |
Prophylaxis - child |
2,177 |
2,069 |
$57K |
| D2332 |
|
505 |
261 |
$48K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,095 |
1,021 |
$35K |
| D1206 |
Topical application of fluoride varnish |
1,089 |
1,033 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
2,132 |
1,996 |
$22K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
156 |
73 |
$19K |
| D7140 |
Extraction, erupted tooth or exposed root |
132 |
49 |
$9K |
| D0272 |
Bitewings - two radiographic images |
390 |
375 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
276 |
251 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
487 |
340 |
$5K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
124 |
55 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
31 |
16 |
$2K |