| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,916 |
4,595 |
$197K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,872 |
1,733 |
$152K |
| D0120 |
Periodic oral evaluation - established patient |
6,800 |
6,370 |
$129K |
| D0330 |
Panoramic radiographic image |
2,079 |
1,899 |
$94K |
| D0274 |
Bitewings - four radiographic images |
3,242 |
3,018 |
$91K |
| D1206 |
Topical application of fluoride varnish |
4,545 |
4,225 |
$87K |
| D0140 |
Limited oral evaluation - problem focused |
2,193 |
2,001 |
$61K |
| D1120 |
Prophylaxis - child |
2,309 |
2,154 |
$59K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,350 |
921 |
$52K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,192 |
1,070 |
$26K |
| D0210 |
Intraoral - complete series of radiographic images |
881 |
829 |
$22K |
| D0272 |
Bitewings - two radiographic images |
1,236 |
1,138 |
$22K |
| D7140 |
Extraction, erupted tooth or exposed root |
407 |
238 |
$19K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
245 |
188 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
1,347 |
1,209 |
$13K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
723 |
615 |
$13K |
| D1351 |
Sealant - per tooth |
322 |
35 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
764 |
711 |
$2K |
| D2331 |
|
33 |
24 |
$2K |
| D2330 |
|
19 |
12 |
$395.90 |