| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
7,753 |
7,698 |
$234K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,469 |
2,409 |
$219K |
| D1206 |
Topical application of fluoride varnish |
9,396 |
9,278 |
$136K |
| D1120 |
Prophylaxis - child |
5,030 |
4,977 |
$120K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,450 |
1,719 |
$117K |
| D0120 |
Periodic oral evaluation - established patient |
7,287 |
7,210 |
$110K |
| D1351 |
Sealant - per tooth |
4,910 |
1,198 |
$99K |
| D0140 |
Limited oral evaluation - problem focused |
3,459 |
3,314 |
$74K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
943 |
782 |
$73K |
| D0274 |
Bitewings - four radiographic images |
3,213 |
3,193 |
$62K |
| D0210 |
Intraoral - complete series of radiographic images |
723 |
719 |
$38K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,512 |
1,498 |
$36K |
| D0272 |
Bitewings - two radiographic images |
2,352 |
2,328 |
$35K |
| D0330 |
Panoramic radiographic image |
1,131 |
1,119 |
$34K |
| D7140 |
Extraction, erupted tooth or exposed root |
832 |
395 |
$31K |
| D0220 |
Intraoral - periapical first radiographic image |
2,621 |
2,518 |
$22K |
| D2331 |
|
353 |
245 |
$19K |
| D1354 |
|
762 |
338 |
$7K |
| D2335 |
|
75 |
67 |
$5K |
| D2330 |
|
128 |
90 |
$5K |
| D4346 |
|
42 |
41 |
$4K |
| D2394 |
|
53 |
49 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
430 |
266 |
$3K |
| D0270 |
|
213 |
206 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
98 |
95 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
548 |
508 |
$0.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
13 |
13 |
$0.00 |