| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,929 |
1,906 |
$122K |
| D0120 |
Periodic oral evaluation - established patient |
2,828 |
2,798 |
$86K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
572 |
368 |
$74K |
| D1120 |
Prophylaxis - child |
1,619 |
1,602 |
$72K |
| D1206 |
Topical application of fluoride varnish |
2,577 |
2,559 |
$65K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
525 |
511 |
$28K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
258 |
163 |
$26K |
| D0274 |
Bitewings - four radiographic images |
697 |
682 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
643 |
636 |
$15K |
| D0330 |
Panoramic radiographic image |
327 |
318 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
722 |
690 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
371 |
358 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
42 |
13 |
$5K |
| D0272 |
Bitewings - two radiographic images |
218 |
217 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
18 |
14 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
16 |
16 |
$756.16 |
| D9910 |
|
71 |
71 |
$710.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
14 |
14 |
$275.66 |