| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,165 |
2,157 |
$76K |
| D0120 |
Periodic oral evaluation - established patient |
2,658 |
2,645 |
$54K |
| D0274 |
Bitewings - four radiographic images |
891 |
891 |
$25K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
473 |
355 |
$24K |
| D1120 |
Prophylaxis - child |
657 |
654 |
$20K |
| D1206 |
Topical application of fluoride varnish |
1,091 |
1,082 |
$20K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
312 |
265 |
$19K |
| D7140 |
Extraction, erupted tooth or exposed root |
212 |
96 |
$14K |
| D1330 |
|
1,000 |
988 |
$11K |
| D1351 |
Sealant - per tooth |
353 |
84 |
$9K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
145 |
124 |
$8K |
| D2331 |
|
117 |
90 |
$7K |
| D1310 |
|
642 |
632 |
$7K |
| D0330 |
Panoramic radiographic image |
174 |
174 |
$6K |
| D2330 |
|
117 |
84 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
661 |
655 |
$5K |
| D0272 |
Bitewings - two radiographic images |
295 |
294 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
188 |
188 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
227 |
193 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
31 |
29 |
$1K |