| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
5,824 |
5,766 |
$294K |
| D0120 |
Periodic oral evaluation - established patient |
5,536 |
5,482 |
$161K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,214 |
805 |
$141K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,273 |
826 |
$104K |
| D0272 |
Bitewings - two radiographic images |
4,420 |
4,374 |
$100K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,353 |
2,324 |
$48K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
651 |
643 |
$34K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
777 |
738 |
$34K |
| D0330 |
Panoramic radiographic image |
468 |
464 |
$28K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
238 |
148 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
1,091 |
1,061 |
$17K |
| D2140 |
|
234 |
155 |
$15K |
| D1120 |
Prophylaxis - child |
458 |
458 |
$15K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
13 |
12 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
13 |
12 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
112 |
110 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
20 |
12 |
$216.41 |