| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,033 |
1,021 |
$32K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
654 |
597 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
278 |
189 |
$10K |
| D0274 |
Bitewings - four radiographic images |
603 |
595 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
662 |
660 |
$8K |
| D9630 |
|
814 |
805 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
142 |
99 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
522 |
504 |
$6K |
| D0330 |
Panoramic radiographic image |
118 |
101 |
$5K |
| D9994 |
|
1,109 |
1,101 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
287 |
284 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
406 |
393 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
33 |
15 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
190 |
190 |
$702.78 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
75 |
45 |
$0.00 |
| D4355 |
|
136 |
136 |
$0.00 |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
29 |
25 |
$0.00 |
| D3120 |
|
167 |
79 |
$0.00 |
| D9920 |
|
88 |
85 |
$0.00 |
| D2950 |
|
67 |
50 |
$0.00 |
| D4341 |
|
35 |
12 |
$0.00 |
| D1120 |
Prophylaxis - child |
68 |
68 |
$0.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
40 |
39 |
$0.00 |
| D7880 |
|
13 |
13 |
$0.00 |
| D2740 |
Crown - porcelain/ceramic |
16 |
13 |
$0.00 |