| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,670 |
1,616 |
$75K |
| D0120 |
Periodic oral evaluation - established patient |
1,976 |
1,935 |
$51K |
| D0140 |
Limited oral evaluation - problem focused |
1,111 |
981 |
$36K |
| D0210 |
Intraoral - complete series of radiographic images |
694 |
632 |
$34K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
805 |
751 |
$34K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
391 |
189 |
$30K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
232 |
137 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
1,827 |
1,720 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,088 |
1,063 |
$20K |
| D1120 |
Prophylaxis - child |
615 |
607 |
$20K |
| D0272 |
Bitewings - two radiographic images |
1,325 |
1,272 |
$19K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
246 |
214 |
$8K |
| D0274 |
Bitewings - four radiographic images |
303 |
299 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
34 |
16 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
247 |
247 |
$3K |
| D0330 |
Panoramic radiographic image |
13 |
13 |
$741.65 |
| D1999 |
|
55 |
44 |
$0.00 |