| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,744 |
3,744 |
$187K |
| D0330 |
Panoramic radiographic image |
2,804 |
2,804 |
$140K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,054 |
711 |
$103K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,448 |
2,448 |
$98K |
| D0140 |
Limited oral evaluation - problem focused |
2,393 |
2,373 |
$89K |
| D0272 |
Bitewings - two radiographic images |
4,037 |
4,037 |
$75K |
| D0120 |
Periodic oral evaluation - established patient |
2,885 |
2,885 |
$66K |
| D7140 |
Extraction, erupted tooth or exposed root |
659 |
369 |
$59K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,419 |
3,419 |
$56K |
| D1120 |
Prophylaxis - child |
1,288 |
1,288 |
$45K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
490 |
311 |
$37K |
| D0220 |
Intraoral - periapical first radiographic image |
2,904 |
2,893 |
$35K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
225 |
152 |
$31K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
822 |
699 |
$27K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,140 |
1,752 |
$19K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
160 |
128 |
$19K |
| D0274 |
Bitewings - four radiographic images |
222 |
222 |
$6K |
| D2335 |
|
21 |
14 |
$2K |
| D1206 |
Topical application of fluoride varnish |
110 |
110 |
$2K |