| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2750 |
|
335 |
265 |
$145K |
| D1110 |
Prophylaxis - adult |
5,355 |
5,328 |
$121K |
| D0120 |
Periodic oral evaluation - established patient |
5,286 |
5,262 |
$75K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,120 |
1,754 |
$45K |
| D0140 |
Limited oral evaluation - problem focused |
1,225 |
1,209 |
$31K |
| D1120 |
Prophylaxis - child |
1,583 |
1,582 |
$26K |
| D1206 |
Topical application of fluoride varnish |
2,087 |
2,082 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,153 |
2,145 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,854 |
6,687 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
7,606 |
7,514 |
$21K |
| D2952 |
|
116 |
98 |
$18K |
| D0274 |
Bitewings - four radiographic images |
3,240 |
3,227 |
$18K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
248 |
144 |
$18K |
| D0272 |
Bitewings - two radiographic images |
2,660 |
2,641 |
$16K |
| D0330 |
Panoramic radiographic image |
603 |
595 |
$13K |
| D9110 |
|
497 |
487 |
$11K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
296 |
198 |
$10K |
| D2335 |
|
81 |
40 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
189 |
90 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
80 |
61 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
15 |
15 |
$315.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
64 |
64 |
$18.00 |