| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,483 |
4,396 |
$139K |
| D0140 |
Limited oral evaluation - problem focused |
2,552 |
2,436 |
$54K |
| D0120 |
Periodic oral evaluation - established patient |
2,891 |
2,847 |
$51K |
| D0274 |
Bitewings - four radiographic images |
2,758 |
2,721 |
$46K |
| D7140 |
Extraction, erupted tooth or exposed root |
909 |
504 |
$36K |
| D1206 |
Topical application of fluoride varnish |
3,258 |
3,175 |
$34K |
| D4910 |
|
458 |
448 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,063 |
1,051 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
2,528 |
2,442 |
$19K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
592 |
453 |
$18K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
607 |
375 |
$14K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
305 |
242 |
$13K |
| D1120 |
Prophylaxis - child |
480 |
463 |
$9K |
| D2140 |
|
359 |
241 |
$9K |
| D2331 |
|
228 |
154 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
198 |
195 |
$8K |
| D4341 |
|
165 |
89 |
$7K |
| D0330 |
Panoramic radiographic image |
361 |
355 |
$3K |
| D2330 |
|
127 |
83 |
$3K |
| D0603 |
|
1,638 |
1,573 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
545 |
289 |
$2K |
| D2160 |
|
47 |
41 |
$2K |
| D1999 |
|
403 |
385 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
71 |
71 |
$1K |
| D2332 |
|
15 |
12 |
$990.00 |
| D0602 |
|
153 |
151 |
$858.00 |
| D0272 |
Bitewings - two radiographic images |
85 |
83 |
$600.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
66 |
61 |
$598.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
13 |
13 |
$588.00 |
| D4355 |
|
13 |
13 |
$252.00 |
| D1330 |
|
2,237 |
2,135 |
$250.00 |
| D1310 |
|
42 |
42 |
$190.00 |
| D0601 |
|
65 |
64 |
$165.00 |
| D1354 |
|
30 |
13 |
$14.00 |