| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,617 |
1,571 |
$73K |
| D0120 |
Periodic oral evaluation - established patient |
2,768 |
2,677 |
$69K |
| D0272 |
Bitewings - two radiographic images |
2,816 |
2,725 |
$65K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,256 |
2,765 |
$56K |
| D0220 |
Intraoral - periapical first radiographic image |
3,294 |
3,143 |
$56K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,866 |
2,780 |
$54K |
| D1120 |
Prophylaxis - child |
1,307 |
1,267 |
$44K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
440 |
260 |
$34K |
| D7140 |
Extraction, erupted tooth or exposed root |
441 |
136 |
$28K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
399 |
243 |
$27K |
| D0140 |
Limited oral evaluation - problem focused |
761 |
699 |
$24K |
| D2140 |
|
247 |
162 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
274 |
177 |
$16K |
| D0330 |
Panoramic radiographic image |
194 |
180 |
$11K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
401 |
324 |
$10K |
| D7111 |
|
177 |
99 |
$8K |
| D0602 |
|
1,338 |
1,295 |
$6K |
| D0601 |
|
1,006 |
976 |
$4K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
21 |
16 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
40 |
15 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
78 |
76 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
18 |
12 |
$2K |
| D0603 |
|
27 |
27 |
$135.00 |