| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2791 |
|
237 |
154 |
$113K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,557 |
1,552 |
$100K |
| D0120 |
Periodic oral evaluation - established patient |
1,552 |
1,544 |
$93K |
| D1120 |
Prophylaxis - child |
1,499 |
1,488 |
$64K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
795 |
438 |
$52K |
| D0210 |
Intraoral - complete series of radiographic images |
1,037 |
1,036 |
$48K |
| D0274 |
Bitewings - four radiographic images |
1,651 |
1,643 |
$33K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,160 |
2,808 |
$26K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,680 |
1,670 |
$25K |
| D9430 |
|
582 |
577 |
$19K |
| D4910 |
|
178 |
178 |
$13K |
| D1310 |
|
136 |
136 |
$6K |
| D1320 |
|
478 |
476 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
515 |
514 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
87 |
38 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
88 |
87 |
$3K |
| D9993 |
|
61 |
61 |
$3K |
| D1351 |
Sealant - per tooth |
116 |
40 |
$3K |
| D1110 |
Prophylaxis - adult |
27 |
27 |
$2K |
| D4341 |
|
32 |
13 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
32 |
25 |
$2K |
| D0601 |
|
72 |
72 |
$1K |
| D0270 |
|
102 |
102 |
$500.00 |
| D0603 |
|
13 |
13 |
$195.00 |