| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
8,840 |
7,317 |
$355K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,637 |
2,227 |
$292K |
| D0120 |
Periodic oral evaluation - established patient |
9,477 |
8,418 |
$234K |
| D0210 |
Intraoral - complete series of radiographic images |
4,785 |
3,733 |
$219K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,116 |
3,942 |
$176K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,897 |
1,567 |
$174K |
| D1120 |
Prophylaxis - child |
4,660 |
4,537 |
$160K |
| D1351 |
Sealant - per tooth |
4,748 |
1,954 |
$126K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,930 |
5,726 |
$114K |
| D0272 |
Bitewings - two radiographic images |
3,875 |
3,730 |
$79K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,375 |
719 |
$71K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
580 |
382 |
$56K |
| D1206 |
Topical application of fluoride varnish |
1,716 |
1,686 |
$41K |
| D0220 |
Intraoral - periapical first radiographic image |
1,617 |
1,334 |
$19K |
| D0274 |
Bitewings - four radiographic images |
681 |
421 |
$14K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
87 |
56 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
285 |
252 |
$5K |
| D0145 |
Oral evaluation for a patient under three years of age |
74 |
70 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
82 |
66 |
$2K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
16 |
12 |
$2K |