| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,317 |
2,251 |
$102K |
| D0210 |
Intraoral - complete series of radiographic images |
1,067 |
1,001 |
$75K |
| D0120 |
Periodic oral evaluation - established patient |
2,799 |
2,715 |
$68K |
| D1206 |
Topical application of fluoride varnish |
3,090 |
3,013 |
$57K |
| D2140 |
|
647 |
380 |
$38K |
| D1120 |
Prophylaxis - child |
1,018 |
999 |
$33K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
508 |
313 |
$28K |
| D0272 |
Bitewings - two radiographic images |
1,269 |
1,226 |
$26K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
993 |
885 |
$24K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
311 |
178 |
$22K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
278 |
167 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
1,315 |
1,246 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
683 |
659 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
506 |
505 |
$16K |
| D0330 |
Panoramic radiographic image |
770 |
759 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,133 |
1,007 |
$14K |
| D1351 |
Sealant - per tooth |
514 |
127 |
$14K |
| D0274 |
Bitewings - four radiographic images |
557 |
553 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
53 |
41 |
$3K |
| D0603 |
|
116 |
114 |
$565.06 |
| D0602 |
|
12 |
12 |
$60.00 |