| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,912 |
5,816 |
$304K |
| D0120 |
Periodic oral evaluation - established patient |
9,095 |
8,886 |
$249K |
| D0210 |
Intraoral - complete series of radiographic images |
3,063 |
2,919 |
$244K |
| D1206 |
Topical application of fluoride varnish |
10,802 |
10,573 |
$224K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,710 |
3,676 |
$142K |
| D1120 |
Prophylaxis - child |
3,747 |
3,654 |
$134K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,073 |
399 |
$105K |
| D0274 |
Bitewings - four radiographic images |
4,160 |
4,090 |
$93K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
841 |
518 |
$77K |
| D1351 |
Sealant - per tooth |
2,708 |
432 |
$75K |
| D4910 |
|
803 |
791 |
$56K |
| D0330 |
Panoramic radiographic image |
2,751 |
2,742 |
$51K |
| D0220 |
Intraoral - periapical first radiographic image |
3,752 |
3,495 |
$38K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,024 |
1,230 |
$29K |
| D0140 |
Limited oral evaluation - problem focused |
462 |
450 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
198 |
132 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
110 |
110 |
$2K |
| D4341 |
|
49 |
17 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
27 |
25 |
$1K |
| D0272 |
Bitewings - two radiographic images |
24 |
24 |
$206.28 |