| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
859 |
844 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
763 |
743 |
$33K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
258 |
181 |
$28K |
| D0210 |
Intraoral - complete series of radiographic images |
360 |
347 |
$24K |
| D0140 |
Limited oral evaluation - problem focused |
400 |
392 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
791 |
767 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
387 |
384 |
$10K |
| D0330 |
Panoramic radiographic image |
164 |
159 |
$9K |
| D0274 |
Bitewings - four radiographic images |
205 |
203 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
74 |
53 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
518 |
326 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
42 |
13 |
$4K |
| D1206 |
Topical application of fluoride varnish |
223 |
220 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
40 |
24 |
$3K |
| D4355 |
|
29 |
26 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
16 |
12 |
$813.96 |
| D1120 |
Prophylaxis - child |
13 |
12 |
$341.52 |