| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
859 |
840 |
$40K |
| D0120 |
Periodic oral evaluation - established patient |
1,212 |
1,183 |
$26K |
| D1206 |
Topical application of fluoride varnish |
1,438 |
1,402 |
$25K |
| D0274 |
Bitewings - four radiographic images |
691 |
674 |
$21K |
| D1120 |
Prophylaxis - child |
541 |
534 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
993 |
978 |
$15K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
132 |
95 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
403 |
401 |
$12K |
| D0330 |
Panoramic radiographic image |
228 |
228 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,165 |
776 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
157 |
151 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
32 |
13 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
45 |
27 |
$3K |
| D0272 |
Bitewings - two radiographic images |
26 |
26 |
$475.68 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
17 |
13 |
$466.48 |