| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,090 |
2,923 |
$147K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,554 |
966 |
$105K |
| D0120 |
Periodic oral evaluation - established patient |
3,430 |
3,269 |
$79K |
| D0274 |
Bitewings - four radiographic images |
2,100 |
1,997 |
$73K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,240 |
834 |
$66K |
| D0140 |
Limited oral evaluation - problem focused |
1,615 |
1,402 |
$59K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,706 |
1,593 |
$56K |
| D7140 |
Extraction, erupted tooth or exposed root |
662 |
291 |
$55K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,747 |
2,578 |
$53K |
| D0330 |
Panoramic radiographic image |
911 |
821 |
$52K |
| D1120 |
Prophylaxis - child |
1,561 |
1,487 |
$47K |
| D0220 |
Intraoral - periapical first radiographic image |
1,219 |
1,101 |
$15K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
70 |
12 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
622 |
407 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
204 |
179 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
64 |
39 |
$5K |
| D0272 |
Bitewings - two radiographic images |
146 |
138 |
$3K |
| D1206 |
Topical application of fluoride varnish |
83 |
82 |
$2K |
| D1999 |
|
285 |
225 |
$558.20 |
| D1330 |
|
131 |
123 |
$0.00 |
| D9215 |
|
12 |
12 |
$0.00 |