| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
10,154 |
10,069 |
$601K |
| D0120 |
Periodic oral evaluation - established patient |
11,533 |
11,446 |
$432K |
| D1206 |
Topical application of fluoride varnish |
14,369 |
14,247 |
$418K |
| D0330 |
Panoramic radiographic image |
4,611 |
4,579 |
$382K |
| D0274 |
Bitewings - four radiographic images |
7,944 |
7,878 |
$331K |
| D0140 |
Limited oral evaluation - problem focused |
6,129 |
6,004 |
$249K |
| D1120 |
Prophylaxis - child |
5,796 |
5,761 |
$222K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,400 |
1,369 |
$192K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,686 |
1,057 |
$178K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,089 |
4,053 |
$175K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,049 |
855 |
$129K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,279 |
1,359 |
$121K |
| D0272 |
Bitewings - two radiographic images |
2,966 |
2,941 |
$104K |
| D0220 |
Intraoral - periapical first radiographic image |
5,420 |
5,300 |
$89K |
| D2140 |
|
1,479 |
882 |
$46K |
| D1351 |
Sealant - per tooth |
2,691 |
613 |
$44K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
926 |
805 |
$19K |
| D2331 |
|
408 |
271 |
$16K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
76 |
62 |
$11K |
| D1330 |
|
592 |
592 |
$9K |
| D0240 |
|
201 |
102 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
281 |
182 |
$3K |
| D2330 |
|
85 |
60 |
$1K |
| D4355 |
|
96 |
96 |
$479.60 |
| D2160 |
|
85 |
71 |
$0.00 |