| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,623 |
5,294 |
$257K |
| D0120 |
Periodic oral evaluation - established patient |
9,709 |
9,087 |
$245K |
| D1206 |
Topical application of fluoride varnish |
9,020 |
8,455 |
$172K |
| D0272 |
Bitewings - two radiographic images |
7,694 |
7,182 |
$162K |
| D1120 |
Prophylaxis - child |
3,999 |
3,726 |
$134K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,512 |
723 |
$111K |
| D0220 |
Intraoral - periapical first radiographic image |
5,777 |
5,334 |
$99K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,494 |
2,867 |
$87K |
| D0210 |
Intraoral - complete series of radiographic images |
1,028 |
1,004 |
$78K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,693 |
4,308 |
$63K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
788 |
409 |
$47K |
| D7111 |
|
750 |
310 |
$34K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
424 |
225 |
$32K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
134 |
82 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
530 |
490 |
$16K |
| D0330 |
Panoramic radiographic image |
723 |
673 |
$14K |
| D2140 |
|
204 |
126 |
$13K |
| D1351 |
Sealant - per tooth |
505 |
128 |
$13K |
| D0603 |
|
2,315 |
2,293 |
$11K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
124 |
68 |
$10K |
| D0602 |
|
1,379 |
1,362 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
46 |
24 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
33 |
31 |
$1K |
| D0601 |
|
27 |
27 |
$135.00 |