| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,646 |
1,601 |
$71K |
| D0210 |
Intraoral - complete series of radiographic images |
887 |
865 |
$47K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,049 |
1,014 |
$46K |
| D0120 |
Periodic oral evaluation - established patient |
1,691 |
1,662 |
$44K |
| D0140 |
Limited oral evaluation - problem focused |
1,343 |
1,308 |
$43K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
287 |
180 |
$31K |
| D0220 |
Intraoral - periapical first radiographic image |
2,041 |
1,988 |
$24K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
279 |
146 |
$22K |
| D0330 |
Panoramic radiographic image |
525 |
508 |
$21K |
| D0272 |
Bitewings - two radiographic images |
854 |
851 |
$19K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
353 |
337 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
658 |
655 |
$13K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
116 |
74 |
$12K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
15 |
12 |
$10K |
| D0274 |
Bitewings - four radiographic images |
355 |
348 |
$9K |
| D9243 |
|
43 |
38 |
$9K |
| D2931 |
|
19 |
12 |
$6K |
| D9239 |
|
41 |
38 |
$6K |
| D1120 |
Prophylaxis - child |
153 |
153 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
465 |
386 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
45 |
26 |
$3K |
| D0270 |
|
185 |
183 |
$2K |