| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,368 |
2,324 |
$117K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,421 |
4,313 |
$112K |
| D1110 |
Prophylaxis - adult |
2,039 |
2,008 |
$93K |
| D0274 |
Bitewings - four radiographic images |
1,793 |
1,762 |
$49K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
746 |
395 |
$43K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,553 |
2,505 |
$36K |
| D0120 |
Periodic oral evaluation - established patient |
1,426 |
1,411 |
$35K |
| D1206 |
Topical application of fluoride varnish |
806 |
803 |
$14K |
| D0330 |
Panoramic radiographic image |
271 |
267 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
787 |
749 |
$6K |
| D9243 |
|
43 |
14 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
108 |
33 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
99 |
95 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
44 |
42 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
54 |
24 |
$2K |
| D9239 |
|
15 |
14 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
21 |
12 |
$1K |
| D0272 |
Bitewings - two radiographic images |
57 |
56 |
$1K |
| D2160 |
|
19 |
12 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
13 |
12 |
$468.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
41 |
12 |
$263.19 |