| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,232 |
2,069 |
$87K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
541 |
207 |
$55K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
664 |
431 |
$50K |
| D0120 |
Periodic oral evaluation - established patient |
2,558 |
2,352 |
$48K |
| D1351 |
Sealant - per tooth |
1,968 |
344 |
$44K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
672 |
437 |
$37K |
| D0274 |
Bitewings - four radiographic images |
1,051 |
969 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
955 |
886 |
$29K |
| D0140 |
Limited oral evaluation - problem focused |
887 |
827 |
$28K |
| D0330 |
Panoramic radiographic image |
666 |
598 |
$27K |
| D1120 |
Prophylaxis - child |
1,013 |
925 |
$26K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,279 |
1,173 |
$20K |
| D2332 |
|
180 |
112 |
$18K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
465 |
283 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
490 |
441 |
$17K |
| D0277 |
|
504 |
463 |
$12K |
| D7250 |
|
80 |
28 |
$11K |
| D1206 |
Topical application of fluoride varnish |
564 |
501 |
$10K |
| D2335 |
|
78 |
35 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
943 |
847 |
$8K |
| D2394 |
|
90 |
67 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
245 |
209 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
54 |
29 |
$4K |
| D0272 |
Bitewings - two radiographic images |
187 |
163 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
47 |
26 |
$405.40 |