| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
6,838 |
6,783 |
$321K |
| D0120 |
Periodic oral evaluation - established patient |
12,044 |
11,930 |
$294K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,008 |
1,334 |
$273K |
| D8660 |
|
1,392 |
1,371 |
$197K |
| D1206 |
Topical application of fluoride varnish |
8,669 |
8,496 |
$160K |
| D1120 |
Prophylaxis - child |
4,577 |
4,512 |
$158K |
| D0274 |
Bitewings - four radiographic images |
3,841 |
3,802 |
$116K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
880 |
637 |
$92K |
| D0220 |
Intraoral - periapical first radiographic image |
3,942 |
3,829 |
$50K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,462 |
1,387 |
$46K |
| D1351 |
Sealant - per tooth |
1,114 |
459 |
$41K |
| D0272 |
Bitewings - two radiographic images |
1,900 |
1,872 |
$40K |
| D0330 |
Panoramic radiographic image |
687 |
685 |
$35K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,111 |
1,092 |
$24K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
185 |
79 |
$23K |
| D7140 |
Extraction, erupted tooth or exposed root |
200 |
93 |
$20K |
| D0190 |
|
1,174 |
1,045 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
333 |
333 |
$13K |
| D8670 |
Periodic orthodontic treatment visit |
56 |
56 |
$7K |
| D9310 |
|
152 |
152 |
$6K |
| D4910 |
|
52 |
50 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
165 |
161 |
$6K |
| D0350 |
|
124 |
124 |
$4K |
| D0391 |
|
45 |
45 |
$4K |
| D0145 |
Oral evaluation for a patient under three years of age |
66 |
66 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
12 |
12 |
$2K |
| D0240 |
|
64 |
63 |
$1K |
| D0180 |
|
36 |
36 |
$1K |
| D1354 |
|
137 |
86 |
$806.74 |
| D0210 |
Intraoral - complete series of radiographic images |
26 |
26 |
$244.47 |