| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,268 |
3,235 |
$176K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,949 |
935 |
$169K |
| D2740 |
Crown - porcelain/ceramic |
210 |
164 |
$152K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,678 |
701 |
$109K |
| D0274 |
Bitewings - four radiographic images |
2,872 |
2,849 |
$98K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,926 |
1,912 |
$86K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,782 |
3,260 |
$85K |
| D0120 |
Periodic oral evaluation - established patient |
3,416 |
3,388 |
$84K |
| D1120 |
Prophylaxis - child |
1,397 |
1,389 |
$72K |
| D0220 |
Intraoral - periapical first radiographic image |
4,080 |
4,000 |
$65K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,095 |
2,085 |
$59K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
534 |
301 |
$47K |
| D0140 |
Limited oral evaluation - problem focused |
745 |
733 |
$30K |
| D2950 |
|
185 |
151 |
$29K |
| D2332 |
|
182 |
104 |
$21K |
| D1351 |
Sealant - per tooth |
516 |
137 |
$21K |
| D0210 |
Intraoral - complete series of radiographic images |
231 |
230 |
$17K |
| D2335 |
|
116 |
56 |
$17K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
946 |
861 |
$16K |
| D0272 |
Bitewings - two radiographic images |
557 |
552 |
$14K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
88 |
44 |
$11K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
69 |
30 |
$6K |
| D0330 |
Panoramic radiographic image |
194 |
187 |
$5K |
| D2331 |
|
53 |
37 |
$5K |
| D2394 |
|
15 |
12 |
$2K |
| D0270 |
|
123 |
122 |
$2K |
| D1206 |
Topical application of fluoride varnish |
47 |
47 |
$1K |
| D2330 |
|
19 |
12 |
$1K |
| D3120 |
|
20 |
14 |
$562.00 |
| D0431 |
|
19 |
19 |
$0.00 |