| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,377 |
2,328 |
$86K |
| D0120 |
Periodic oral evaluation - established patient |
3,957 |
3,865 |
$74K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
908 |
535 |
$62K |
| D1120 |
Prophylaxis - child |
2,172 |
2,099 |
$59K |
| D0274 |
Bitewings - four radiographic images |
2,293 |
2,223 |
$53K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,199 |
2,179 |
$35K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,146 |
1,107 |
$28K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
463 |
297 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
2,214 |
2,110 |
$22K |
| D1206 |
Topical application of fluoride varnish |
1,176 |
1,119 |
$17K |
| D2740 |
Crown - porcelain/ceramic |
39 |
27 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
665 |
631 |
$16K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
138 |
52 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,583 |
1,192 |
$11K |
| D1351 |
Sealant - per tooth |
402 |
38 |
$8K |
| D4910 |
|
112 |
110 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
140 |
136 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
96 |
37 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
300 |
271 |
$5K |
| D0330 |
Panoramic radiographic image |
99 |
98 |
$3K |
| D0603 |
|
358 |
354 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
14 |
12 |
$1K |
| D1354 |
|
21 |
12 |
$109.60 |