| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,285 |
2,229 |
$104K |
| D0210 |
Intraoral - complete series of radiographic images |
1,138 |
1,069 |
$88K |
| D0120 |
Periodic oral evaluation - established patient |
2,579 |
2,502 |
$64K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,057 |
2,985 |
$58K |
| D0272 |
Bitewings - two radiographic images |
2,112 |
2,063 |
$50K |
| D0220 |
Intraoral - periapical first radiographic image |
2,585 |
2,507 |
$45K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,805 |
1,630 |
$40K |
| D0140 |
Limited oral evaluation - problem focused |
1,038 |
1,018 |
$34K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,236 |
2,179 |
$30K |
| D1120 |
Prophylaxis - child |
547 |
530 |
$19K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
115 |
91 |
$15K |
| D7140 |
Extraction, erupted tooth or exposed root |
143 |
59 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
128 |
90 |
$9K |
| D0603 |
|
1,970 |
1,931 |
$9K |
| D4341 |
|
73 |
37 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
248 |
248 |
$8K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
96 |
68 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
38 |
29 |
$2K |
| D1351 |
Sealant - per tooth |
36 |
12 |
$940.50 |
| D0602 |
|
37 |
37 |
$185.00 |