| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,470 |
3,161 |
$149K |
| D0120 |
Periodic oral evaluation - established patient |
4,802 |
4,376 |
$97K |
| D0210 |
Intraoral - complete series of radiographic images |
2,088 |
1,414 |
$68K |
| D0274 |
Bitewings - four radiographic images |
2,191 |
1,962 |
$65K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,450 |
1,289 |
$46K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,744 |
3,388 |
$44K |
| D1120 |
Prophylaxis - child |
1,634 |
1,466 |
$41K |
| D0220 |
Intraoral - periapical first radiographic image |
3,788 |
3,347 |
$37K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,827 |
3,008 |
$37K |
| D0140 |
Limited oral evaluation - problem focused |
1,123 |
1,018 |
$36K |
| D1351 |
Sealant - per tooth |
1,487 |
282 |
$30K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
429 |
263 |
$29K |
| D0330 |
Panoramic radiographic image |
652 |
575 |
$28K |
| D0272 |
Bitewings - two radiographic images |
1,183 |
1,067 |
$22K |
| D4210 |
|
50 |
12 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
240 |
202 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
29 |
13 |
$4K |
| D2331 |
|
29 |
12 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
19 |
12 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
20 |
14 |
$960.15 |
| D0240 |
|
77 |
24 |
$814.00 |
| D1206 |
Topical application of fluoride varnish |
14 |
12 |
$132.00 |