| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,586 |
3,477 |
$147K |
| D2750 |
|
232 |
140 |
$106K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,893 |
4,745 |
$96K |
| D0120 |
Periodic oral evaluation - established patient |
3,791 |
3,684 |
$86K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,049 |
633 |
$71K |
| D0274 |
Bitewings - four radiographic images |
3,176 |
3,067 |
$67K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,304 |
2,013 |
$62K |
| D0330 |
Panoramic radiographic image |
1,751 |
1,690 |
$50K |
| D1120 |
Prophylaxis - child |
1,513 |
1,478 |
$48K |
| D2954 |
|
275 |
179 |
$42K |
| D0220 |
Intraoral - periapical first radiographic image |
3,893 |
3,643 |
$36K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,068 |
1,026 |
$29K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
428 |
266 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,719 |
3,005 |
$23K |
| D0272 |
Bitewings - two radiographic images |
1,396 |
1,359 |
$20K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
245 |
158 |
$17K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
17 |
12 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
299 |
285 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
81 |
57 |
$6K |
| D2160 |
|
35 |
27 |
$3K |
| D2332 |
|
18 |
12 |
$1K |
| D1330 |
|
15 |
13 |
$0.00 |
| D1999 |
|
18 |
17 |
$0.00 |