| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,691 |
3,347 |
$157K |
| D0120 |
Periodic oral evaluation - established patient |
6,066 |
5,481 |
$118K |
| D1120 |
Prophylaxis - child |
3,093 |
2,764 |
$75K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,159 |
4,676 |
$74K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,378 |
717 |
$74K |
| D0274 |
Bitewings - four radiographic images |
1,942 |
1,738 |
$58K |
| D0140 |
Limited oral evaluation - problem focused |
1,669 |
1,451 |
$46K |
| D0330 |
Panoramic radiographic image |
898 |
797 |
$34K |
| D0272 |
Bitewings - two radiographic images |
1,297 |
1,160 |
$23K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
386 |
199 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
1,034 |
883 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
464 |
407 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
385 |
336 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
222 |
121 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
423 |
378 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
18 |
12 |
$2K |