| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,261 |
1,104 |
$45K |
| D0120 |
Periodic oral evaluation - established patient |
1,825 |
1,598 |
$33K |
| D1206 |
Topical application of fluoride varnish |
1,206 |
1,070 |
$20K |
| D0140 |
Limited oral evaluation - problem focused |
701 |
624 |
$18K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
190 |
107 |
$14K |
| D0274 |
Bitewings - four radiographic images |
582 |
518 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
233 |
94 |
$12K |
| D1120 |
Prophylaxis - child |
448 |
405 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
462 |
404 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
958 |
798 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
208 |
169 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
386 |
298 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
152 |
121 |
$3K |
| D0330 |
Panoramic radiographic image |
95 |
84 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
36 |
26 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
135 |
123 |
$335.85 |
| D0272 |
Bitewings - two radiographic images |
16 |
14 |
$322.53 |