| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
8,051 |
7,804 |
$281K |
| D0120 |
Periodic oral evaluation - established patient |
10,780 |
10,440 |
$194K |
| D1206 |
Topical application of fluoride varnish |
7,109 |
6,874 |
$112K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,824 |
1,029 |
$109K |
| D0210 |
Intraoral - complete series of radiographic images |
1,492 |
1,451 |
$90K |
| D1120 |
Prophylaxis - child |
3,958 |
3,847 |
$83K |
| D0274 |
Bitewings - four radiographic images |
3,561 |
3,442 |
$72K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,231 |
1,215 |
$35K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,834 |
2,285 |
$23K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
415 |
258 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
3,410 |
3,252 |
$17K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
204 |
144 |
$15K |
| D7140 |
Extraction, erupted tooth or exposed root |
227 |
93 |
$12K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
161 |
92 |
$9K |
| D0272 |
Bitewings - two radiographic images |
671 |
642 |
$7K |
| D1351 |
Sealant - per tooth |
295 |
74 |
$6K |
| D2160 |
|
80 |
60 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
195 |
179 |
$4K |
| D2140 |
|
80 |
54 |
$3K |
| D0330 |
Panoramic radiographic image |
24 |
24 |
$1K |
| D2331 |
|
17 |
12 |
$1K |
| D1320 |
|
27 |
27 |
$525.30 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
13 |
12 |
$250.00 |