| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,263 |
1,990 |
$93K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,550 |
2,043 |
$77K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,358 |
800 |
$75K |
| D0210 |
Intraoral - complete series of radiographic images |
1,432 |
1,233 |
$73K |
| D0120 |
Periodic oral evaluation - established patient |
2,705 |
2,472 |
$67K |
| D1120 |
Prophylaxis - child |
1,908 |
1,759 |
$60K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,441 |
1,206 |
$50K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,645 |
2,418 |
$47K |
| D1351 |
Sealant - per tooth |
902 |
272 |
$23K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
41 |
31 |
$15K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
238 |
139 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
978 |
847 |
$12K |
| D2950 |
|
117 |
92 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
738 |
689 |
$10K |
| D0272 |
Bitewings - two radiographic images |
432 |
410 |
$8K |
| D0330 |
Panoramic radiographic image |
180 |
150 |
$8K |
| D1206 |
Topical application of fluoride varnish |
191 |
190 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
42 |
31 |
$347.76 |