| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2750 |
|
573 |
288 |
$280K |
| D1110 |
Prophylaxis - adult |
1,735 |
1,701 |
$117K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
527 |
293 |
$69K |
| D0120 |
Periodic oral evaluation - established patient |
1,599 |
1,571 |
$49K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,957 |
1,924 |
$48K |
| D9310 |
|
571 |
511 |
$46K |
| D0274 |
Bitewings - four radiographic images |
1,026 |
1,009 |
$39K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
336 |
180 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
445 |
442 |
$31K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
208 |
103 |
$28K |
| D0330 |
Panoramic radiographic image |
340 |
337 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
887 |
824 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
213 |
209 |
$10K |
| D1120 |
Prophylaxis - child |
69 |
69 |
$3K |
| D0367 |
|
13 |
12 |
$3K |
| D4910 |
|
40 |
40 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
61 |
55 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
143 |
114 |
$2K |
| D9110 |
|
27 |
26 |
$2K |
| D1206 |
Topical application of fluoride varnish |
47 |
47 |
$1K |