| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,252 |
4,205 |
$180K |
| D0120 |
Periodic oral evaluation - established patient |
8,894 |
8,781 |
$177K |
| D1120 |
Prophylaxis - child |
5,567 |
5,500 |
$162K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,662 |
943 |
$158K |
| D0330 |
Panoramic radiographic image |
2,873 |
2,846 |
$135K |
| D0220 |
Intraoral - periapical first radiographic image |
8,814 |
8,625 |
$128K |
| D0274 |
Bitewings - four radiographic images |
3,993 |
3,934 |
$115K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,652 |
5,652 |
$81K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,624 |
2,583 |
$77K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,152 |
6,886 |
$67K |
| D1206 |
Topical application of fluoride varnish |
2,898 |
2,788 |
$51K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
823 |
545 |
$47K |
| D0140 |
Limited oral evaluation - problem focused |
1,613 |
1,583 |
$46K |
| D0272 |
Bitewings - two radiographic images |
2,612 |
2,580 |
$45K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,397 |
1,291 |
$36K |
| D1351 |
Sealant - per tooth |
1,079 |
246 |
$25K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
163 |
112 |
$20K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
127 |
68 |
$15K |
| D7140 |
Extraction, erupted tooth or exposed root |
214 |
113 |
$14K |
| D3120 |
|
113 |
85 |
$3K |
| D0602 |
|
233 |
233 |
$2K |
| D0601 |
|
231 |
231 |
$2K |
| D0240 |
|
14 |
14 |
$256.06 |
| D0603 |
|
14 |
14 |
$128.10 |