| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0274 |
Bitewings - four radiographic images |
1,886 |
1,792 |
$50K |
| D1110 |
Prophylaxis - adult |
1,335 |
1,248 |
$39K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,952 |
1,822 |
$39K |
| D0330 |
Panoramic radiographic image |
767 |
702 |
$38K |
| D0120 |
Periodic oral evaluation - established patient |
1,516 |
1,432 |
$32K |
| D0220 |
Intraoral - periapical first radiographic image |
2,754 |
2,132 |
$31K |
| D1206 |
Topical application of fluoride varnish |
1,312 |
1,249 |
$24K |
| D0140 |
Limited oral evaluation - problem focused |
782 |
702 |
$22K |
| D0470 |
|
213 |
200 |
$12K |
| D1120 |
Prophylaxis - child |
288 |
270 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
212 |
202 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
96 |
93 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
30 |
17 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
13 |
12 |
$2K |
| D2394 |
|
14 |
12 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
20 |
13 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
44 |
42 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
15 |
13 |
$795.60 |