| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,094 |
2,757 |
$147K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
847 |
544 |
$81K |
| D1351 |
Sealant - per tooth |
2,903 |
453 |
$77K |
| D0120 |
Periodic oral evaluation - established patient |
3,274 |
2,930 |
$73K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,589 |
1,392 |
$62K |
| D0330 |
Panoramic radiographic image |
1,780 |
1,575 |
$61K |
| D2332 |
|
585 |
301 |
$61K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
785 |
525 |
$58K |
| D0274 |
Bitewings - four radiographic images |
1,649 |
1,484 |
$48K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
235 |
138 |
$39K |
| D0210 |
Intraoral - complete series of radiographic images |
806 |
627 |
$37K |
| D1120 |
Prophylaxis - child |
1,172 |
1,056 |
$37K |
| D0140 |
Limited oral evaluation - problem focused |
999 |
852 |
$35K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,536 |
1,416 |
$30K |
| D1206 |
Topical application of fluoride varnish |
1,062 |
947 |
$21K |
| D4346 |
|
144 |
131 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
1,730 |
1,454 |
$16K |
| D0277 |
|
744 |
618 |
$14K |
| D2335 |
|
133 |
69 |
$14K |
| D7140 |
Extraction, erupted tooth or exposed root |
218 |
89 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
240 |
166 |
$12K |
| D7250 |
|
46 |
27 |
$10K |
| D2394 |
|
53 |
36 |
$6K |
| D0272 |
Bitewings - two radiographic images |
268 |
229 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
556 |
315 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
84 |
67 |
$2K |