| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,438 |
3,392 |
$142K |
| D0120 |
Periodic oral evaluation - established patient |
5,019 |
4,950 |
$104K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,039 |
600 |
$78K |
| D1120 |
Prophylaxis - child |
1,662 |
1,650 |
$44K |
| D2740 |
Crown - porcelain/ceramic |
92 |
65 |
$44K |
| D0210 |
Intraoral - complete series of radiographic images |
682 |
665 |
$36K |
| D0140 |
Limited oral evaluation - problem focused |
1,748 |
1,675 |
$32K |
| D0274 |
Bitewings - four radiographic images |
1,508 |
1,476 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
3,450 |
3,344 |
$25K |
| D2954 |
|
171 |
145 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,320 |
1,311 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
691 |
691 |
$16K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
163 |
114 |
$15K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
151 |
73 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
211 |
148 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,849 |
1,639 |
$7K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
35 |
15 |
$4K |
| D0272 |
Bitewings - two radiographic images |
247 |
247 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
137 |
127 |
$2K |
| D9310 |
|
77 |
77 |
$2K |
| D2950 |
|
21 |
12 |
$2K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
21 |
12 |
$1K |
| D1206 |
Topical application of fluoride varnish |
112 |
112 |
$671.00 |
| D0270 |
|
69 |
68 |
$552.00 |
| D0603 |
|
53 |
53 |
$530.00 |