| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,198 |
2,185 |
$110K |
| D0120 |
Periodic oral evaluation - established patient |
3,010 |
2,989 |
$99K |
| D1206 |
Topical application of fluoride varnish |
2,566 |
2,554 |
$67K |
| D0274 |
Bitewings - four radiographic images |
1,829 |
1,820 |
$65K |
| D0330 |
Panoramic radiographic image |
993 |
989 |
$61K |
| D1120 |
Prophylaxis - child |
1,504 |
1,496 |
$48K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
425 |
272 |
$38K |
| D0140 |
Limited oral evaluation - problem focused |
984 |
954 |
$32K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,067 |
1,063 |
$32K |
| D0272 |
Bitewings - two radiographic images |
832 |
830 |
$25K |
| D7140 |
Extraction, erupted tooth or exposed root |
240 |
137 |
$21K |
| D1351 |
Sealant - per tooth |
633 |
198 |
$20K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
171 |
107 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
793 |
781 |
$10K |
| D0160 |
|
36 |
34 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
20 |
14 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
101 |
91 |
$2K |
| D2140 |
|
15 |
12 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
66 |
49 |
$996.34 |
| D1999 |
|
440 |
375 |
$0.00 |