| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,187 |
5,106 |
$191K |
| D1206 |
Topical application of fluoride varnish |
11,048 |
10,870 |
$172K |
| D1351 |
Sealant - per tooth |
6,698 |
1,272 |
$147K |
| D0120 |
Periodic oral evaluation - established patient |
7,896 |
7,783 |
$145K |
| D1120 |
Prophylaxis - child |
3,822 |
3,755 |
$106K |
| D0274 |
Bitewings - four radiographic images |
4,332 |
4,252 |
$98K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,119 |
844 |
$88K |
| D4910 |
|
1,311 |
1,283 |
$77K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,346 |
1,054 |
$77K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,038 |
2,959 |
$72K |
| D0330 |
Panoramic radiographic image |
1,408 |
1,381 |
$46K |
| D0220 |
Intraoral - periapical first radiographic image |
4,577 |
4,261 |
$45K |
| D0140 |
Limited oral evaluation - problem focused |
1,701 |
1,627 |
$42K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
700 |
543 |
$40K |
| D2140 |
|
754 |
573 |
$35K |
| D0210 |
Intraoral - complete series of radiographic images |
617 |
610 |
$29K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,288 |
1,194 |
$28K |
| D4341 |
|
284 |
114 |
$25K |
| D2940 |
|
751 |
637 |
$22K |
| D2160 |
|
291 |
249 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,188 |
1,320 |
$17K |
| D0272 |
Bitewings - two radiographic images |
726 |
713 |
$13K |
| D2335 |
|
131 |
89 |
$10K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
95 |
79 |
$8K |
| D2740 |
Crown - porcelain/ceramic |
15 |
13 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
30 |
25 |
$1K |
| D2161 |
|
15 |
14 |
$1K |