| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,139 |
1,075 |
$36K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
571 |
397 |
$26K |
| D0120 |
Periodic oral evaluation - established patient |
1,522 |
1,434 |
$23K |
| D0274 |
Bitewings - four radiographic images |
956 |
891 |
$22K |
| D1351 |
Sealant - per tooth |
853 |
186 |
$14K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
217 |
150 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
328 |
323 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
665 |
623 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
304 |
283 |
$7K |
| D0330 |
Panoramic radiographic image |
168 |
156 |
$5K |
| D0272 |
Bitewings - two radiographic images |
349 |
330 |
$4K |
| D1120 |
Prophylaxis - child |
295 |
279 |
$4K |
| D2330 |
|
37 |
26 |
$2K |
| D2331 |
|
21 |
12 |
$2K |
| D1206 |
Topical application of fluoride varnish |
71 |
70 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
127 |
115 |
$858.73 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
38 |
38 |
$741.95 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
33 |
28 |
$278.55 |
| D1999 |
|
20 |
20 |
$0.00 |