| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,152 |
3,005 |
$115K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,057 |
570 |
$107K |
| D0120 |
Periodic oral evaluation - established patient |
3,688 |
3,554 |
$93K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,232 |
393 |
$72K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,446 |
1,335 |
$58K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,629 |
2,338 |
$55K |
| D0220 |
Intraoral - periapical first radiographic image |
3,484 |
3,242 |
$50K |
| D0330 |
Panoramic radiographic image |
1,128 |
1,040 |
$49K |
| D1120 |
Prophylaxis - child |
1,744 |
1,674 |
$46K |
| D1206 |
Topical application of fluoride varnish |
2,806 |
2,692 |
$44K |
| D0140 |
Limited oral evaluation - problem focused |
1,166 |
1,055 |
$39K |
| D0274 |
Bitewings - four radiographic images |
1,146 |
1,083 |
$33K |
| D0210 |
Intraoral - complete series of radiographic images |
529 |
486 |
$30K |
| D1351 |
Sealant - per tooth |
972 |
249 |
$27K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
190 |
119 |
$23K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
200 |
58 |
$18K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
176 |
115 |
$12K |
| D0272 |
Bitewings - two radiographic images |
637 |
603 |
$11K |
| D4355 |
|
101 |
84 |
$6K |
| D2950 |
|
22 |
12 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
20 |
18 |
$849.86 |
| D1208 |
Topical application of fluoride, excluding varnish |
44 |
42 |
$644.52 |
| D0367 |
|
14 |
14 |
$0.00 |