| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,452 |
2,394 |
$147K |
| D0330 |
Panoramic radiographic image |
1,508 |
1,471 |
$132K |
| D0140 |
Limited oral evaluation - problem focused |
3,032 |
2,866 |
$122K |
| D0120 |
Periodic oral evaluation - established patient |
3,190 |
3,124 |
$116K |
| D0274 |
Bitewings - four radiographic images |
2,561 |
2,510 |
$111K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,001 |
561 |
$104K |
| D1206 |
Topical application of fluoride varnish |
2,890 |
2,829 |
$94K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
823 |
624 |
$81K |
| D1120 |
Prophylaxis - child |
1,146 |
1,129 |
$50K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,035 |
1,016 |
$47K |
| D0220 |
Intraoral - periapical first radiographic image |
2,540 |
2,424 |
$40K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
421 |
295 |
$33K |
| D0272 |
Bitewings - two radiographic images |
700 |
692 |
$26K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
108 |
92 |
$11K |
| D9110 |
|
146 |
142 |
$7K |
| D1351 |
Sealant - per tooth |
167 |
50 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
665 |
364 |
$6K |
| D2331 |
|
61 |
40 |
$6K |
| D0270 |
|
405 |
378 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
23 |
13 |
$3K |
| D2140 |
|
42 |
29 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
13 |
12 |
$2K |
| D2330 |
|
18 |
12 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
31 |
29 |
$628.68 |
| D1354 |
|
13 |
12 |
$276.00 |