| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1208 |
Topical application of fluoride, excluding varnish |
4,895 |
4,800 |
$89K |
| D4910 |
|
1,317 |
1,296 |
$86K |
| D0120 |
Periodic oral evaluation - established patient |
2,887 |
2,842 |
$77K |
| D1110 |
Prophylaxis - adult |
1,660 |
1,627 |
$74K |
| D1120 |
Prophylaxis - child |
1,764 |
1,739 |
$69K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
687 |
382 |
$45K |
| D9630 |
|
2,109 |
2,044 |
$37K |
| D0274 |
Bitewings - four radiographic images |
1,067 |
1,049 |
$29K |
| D0140 |
Limited oral evaluation - problem focused |
812 |
775 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
2,083 |
2,022 |
$26K |
| D4341 |
|
250 |
105 |
$22K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
339 |
195 |
$21K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
347 |
186 |
$18K |
| D0603 |
|
1,666 |
1,616 |
$17K |
| D0210 |
Intraoral - complete series of radiographic images |
277 |
257 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,738 |
1,619 |
$15K |
| D1330 |
|
1,673 |
1,618 |
$15K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
397 |
326 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
222 |
208 |
$8K |
| D1351 |
Sealant - per tooth |
296 |
75 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
87 |
46 |
$7K |
| D1320 |
|
520 |
513 |
$5K |
| D2140 |
|
82 |
45 |
$3K |
| D9310 |
|
47 |
45 |
$2K |
| D2160 |
|
31 |
24 |
$2K |
| D0272 |
Bitewings - two radiographic images |
40 |
39 |
$760.00 |
| D0601 |
|
12 |
12 |
$132.00 |
| D1999 |
|
17 |
15 |
$7.00 |