| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,669 |
2,412 |
$110K |
| D0120 |
Periodic oral evaluation - established patient |
2,734 |
2,498 |
$54K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
704 |
426 |
$46K |
| D0274 |
Bitewings - four radiographic images |
1,191 |
1,095 |
$38K |
| D0210 |
Intraoral - complete series of radiographic images |
493 |
431 |
$32K |
| D0140 |
Limited oral evaluation - problem focused |
847 |
750 |
$30K |
| D7140 |
Extraction, erupted tooth or exposed root |
364 |
173 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
579 |
515 |
$20K |
| D0330 |
Panoramic radiographic image |
335 |
297 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
1,555 |
1,284 |
$15K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
133 |
91 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,080 |
648 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
228 |
195 |
$4K |
| D1120 |
Prophylaxis - child |
163 |
145 |
$4K |
| D2335 |
|
21 |
12 |
$3K |
| D1206 |
Topical application of fluoride varnish |
208 |
191 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
13 |
12 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
20 |
13 |
$945.05 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
38 |
33 |
$524.91 |