| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,763 |
4,731 |
$207K |
| D0330 |
Panoramic radiographic image |
3,003 |
2,965 |
$176K |
| D0120 |
Periodic oral evaluation - established patient |
5,623 |
5,586 |
$151K |
| D1206 |
Topical application of fluoride varnish |
6,121 |
6,081 |
$138K |
| D0274 |
Bitewings - four radiographic images |
4,356 |
4,331 |
$137K |
| D0140 |
Limited oral evaluation - problem focused |
3,874 |
3,769 |
$116K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,418 |
974 |
$91K |
| D1120 |
Prophylaxis - child |
2,664 |
2,644 |
$81K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,082 |
713 |
$73K |
| D2140 |
|
1,208 |
746 |
$61K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,016 |
2,005 |
$60K |
| D1351 |
Sealant - per tooth |
2,382 |
575 |
$53K |
| D0272 |
Bitewings - two radiographic images |
1,687 |
1,673 |
$46K |
| D0220 |
Intraoral - periapical first radiographic image |
3,563 |
3,486 |
$42K |
| D7140 |
Extraction, erupted tooth or exposed root |
581 |
379 |
$39K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
486 |
337 |
$23K |
| D2331 |
|
305 |
196 |
$19K |
| D2160 |
|
206 |
174 |
$17K |
| D9110 |
|
336 |
319 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,203 |
883 |
$9K |
| D2330 |
|
53 |
38 |
$3K |
| D2940 |
|
92 |
76 |
$3K |
| D4355 |
|
95 |
95 |
$3K |
| D2332 |
|
16 |
13 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
137 |
129 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
25 |
25 |
$702.12 |
| D0270 |
|
47 |
46 |
$673.89 |
| D1999 |
|
573 |
474 |
$20.75 |
| D9995 |
|
13 |
13 |
$0.00 |