| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,903 |
1,879 |
$105K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,642 |
1,619 |
$79K |
| D0210 |
Intraoral - complete series of radiographic images |
911 |
892 |
$70K |
| D1120 |
Prophylaxis - child |
1,210 |
1,208 |
$64K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,784 |
1,782 |
$53K |
| D0120 |
Periodic oral evaluation - established patient |
1,844 |
1,840 |
$47K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
360 |
195 |
$36K |
| D0274 |
Bitewings - four radiographic images |
916 |
911 |
$31K |
| D1351 |
Sealant - per tooth |
796 |
179 |
$31K |
| D0140 |
Limited oral evaluation - problem focused |
664 |
652 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
1,775 |
1,712 |
$25K |
| D0330 |
Panoramic radiographic image |
444 |
438 |
$25K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
341 |
185 |
$24K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
139 |
56 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,662 |
918 |
$16K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
79 |
52 |
$7K |
| D0272 |
Bitewings - two radiographic images |
112 |
112 |
$3K |
| D2335 |
|
17 |
12 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
73 |
64 |
$2K |
| D0270 |
|
13 |
12 |
$147.00 |