| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
8,437 |
8,106 |
$490K |
| D1120 |
Prophylaxis - child |
6,997 |
6,783 |
$345K |
| D0120 |
Periodic oral evaluation - established patient |
12,925 |
12,485 |
$338K |
| D2740 |
Crown - porcelain/ceramic |
396 |
202 |
$271K |
| D1206 |
Topical application of fluoride varnish |
9,597 |
9,277 |
$244K |
| D0274 |
Bitewings - four radiographic images |
4,529 |
4,353 |
$172K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,775 |
1,066 |
$169K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,386 |
803 |
$109K |
| D9450 |
|
5,954 |
5,660 |
$108K |
| D0330 |
Panoramic radiographic image |
1,377 |
1,352 |
$101K |
| D1351 |
Sealant - per tooth |
1,665 |
392 |
$63K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
788 |
745 |
$35K |
| D0140 |
Limited oral evaluation - problem focused |
781 |
746 |
$32K |
| D1208 |
Topical application of fluoride, excluding varnish |
832 |
830 |
$23K |
| D0272 |
Bitewings - two radiographic images |
718 |
708 |
$20K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
188 |
122 |
$19K |
| D2950 |
|
106 |
78 |
$17K |
| D9945 |
|
42 |
42 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
565 |
536 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
116 |
105 |
$7K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
26 |
13 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
12 |
12 |
$231.00 |
| D0240 |
|
25 |
25 |
$0.00 |