| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,543 |
3,454 |
$247K |
| D0120 |
Periodic oral evaluation - established patient |
4,663 |
4,589 |
$171K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,427 |
1,168 |
$165K |
| D1206 |
Topical application of fluoride varnish |
4,502 |
4,428 |
$157K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,615 |
851 |
$133K |
| D0274 |
Bitewings - four radiographic images |
2,507 |
2,450 |
$111K |
| D1120 |
Prophylaxis - child |
1,799 |
1,781 |
$86K |
| D0220 |
Intraoral - periapical first radiographic image |
3,810 |
3,705 |
$76K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,573 |
2,542 |
$65K |
| D2721 |
|
43 |
25 |
$56K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
322 |
130 |
$46K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
293 |
168 |
$37K |
| D2331 |
|
288 |
141 |
$36K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
795 |
773 |
$32K |
| D0330 |
Panoramic radiographic image |
437 |
431 |
$24K |
| D0140 |
Limited oral evaluation - problem focused |
421 |
415 |
$21K |
| D2950 |
|
64 |
46 |
$16K |
| D2140 |
|
100 |
67 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
47 |
12 |
$6K |
| D2330 |
|
48 |
26 |
$5K |
| D0272 |
Bitewings - two radiographic images |
138 |
138 |
$5K |
| D2160 |
|
17 |
13 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
16 |
15 |
$292.01 |
| D1999 |
|
836 |
622 |
$0.00 |
| D9985 |
|
3,155 |
2,359 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
77 |
53 |
$0.00 |