| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
7,719 |
7,538 |
$361K |
| D0120 |
Periodic oral evaluation - established patient |
10,008 |
9,789 |
$267K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,931 |
875 |
$185K |
| D0330 |
Panoramic radiographic image |
2,916 |
2,844 |
$165K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,456 |
743 |
$130K |
| D0272 |
Bitewings - two radiographic images |
7,272 |
7,094 |
$129K |
| D1120 |
Prophylaxis - child |
3,008 |
2,940 |
$102K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,106 |
4,999 |
$99K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,990 |
1,815 |
$70K |
| D2160 |
|
509 |
277 |
$57K |
| D2931 |
|
325 |
218 |
$55K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
107 |
85 |
$48K |
| D0220 |
Intraoral - periapical first radiographic image |
4,401 |
4,264 |
$48K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
913 |
904 |
$43K |
| D2140 |
|
609 |
376 |
$40K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
541 |
320 |
$34K |
| D0210 |
Intraoral - complete series of radiographic images |
534 |
530 |
$32K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
258 |
128 |
$32K |
| D1351 |
Sealant - per tooth |
1,071 |
480 |
$29K |
| D7220 |
|
169 |
84 |
$24K |
| D1206 |
Topical application of fluoride varnish |
539 |
538 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,946 |
1,721 |
$13K |
| D9243 |
|
204 |
59 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
676 |
649 |
$10K |
| D2950 |
|
80 |
59 |
$9K |
| D9239 |
|
74 |
60 |
$7K |