| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,415 |
1,137 |
$48K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
561 |
316 |
$47K |
| D1110 |
Prophylaxis - adult |
1,190 |
1,033 |
$38K |
| D0120 |
Periodic oral evaluation - established patient |
1,307 |
1,161 |
$30K |
| D1120 |
Prophylaxis - child |
1,232 |
1,030 |
$27K |
| D7140 |
Extraction, erupted tooth or exposed root |
376 |
173 |
$26K |
| D0274 |
Bitewings - four radiographic images |
920 |
781 |
$22K |
| D0330 |
Panoramic radiographic image |
617 |
545 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
1,574 |
1,332 |
$20K |
| D1206 |
Topical application of fluoride varnish |
1,220 |
1,021 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,561 |
1,133 |
$16K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
130 |
57 |
$12K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
290 |
205 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
161 |
144 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
41 |
26 |
$5K |
| D4355 |
|
44 |
43 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
41 |
27 |
$3K |
| D0272 |
Bitewings - two radiographic images |
219 |
174 |
$3K |
| D2332 |
|
20 |
13 |
$2K |
| D1351 |
Sealant - per tooth |
47 |
12 |
$1K |