| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,463 |
3,833 |
$174K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,174 |
418 |
$149K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,303 |
1,096 |
$147K |
| D0210 |
Intraoral - complete series of radiographic images |
2,622 |
2,261 |
$121K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,500 |
453 |
$111K |
| D0120 |
Periodic oral evaluation - established patient |
5,260 |
4,480 |
$98K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,048 |
2,600 |
$95K |
| D0274 |
Bitewings - four radiographic images |
2,623 |
2,214 |
$71K |
| D4212 |
|
169 |
60 |
$63K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
577 |
349 |
$50K |
| D1206 |
Topical application of fluoride varnish |
2,808 |
2,387 |
$45K |
| D0330 |
Panoramic radiographic image |
1,250 |
1,029 |
$41K |
| D1120 |
Prophylaxis - child |
1,725 |
1,466 |
$39K |
| D0140 |
Limited oral evaluation - problem focused |
1,232 |
1,037 |
$39K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
554 |
303 |
$25K |
| D7250 |
|
101 |
27 |
$15K |
| D2332 |
|
73 |
41 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
802 |
664 |
$8K |
| D2331 |
|
88 |
39 |
$6K |
| D1351 |
Sealant - per tooth |
195 |
29 |
$4K |
| D2335 |
|
24 |
12 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
34 |
15 |
$2K |
| D1999 |
|
729 |
573 |
$1K |
| D0272 |
Bitewings - two radiographic images |
50 |
43 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
114 |
83 |
$581.89 |