| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0274 |
Bitewings - four radiographic images |
3,089 |
3,089 |
$85K |
| D1120 |
Prophylaxis - child |
2,725 |
2,725 |
$84K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,579 |
3,579 |
$63K |
| D0120 |
Periodic oral evaluation - established patient |
2,379 |
2,379 |
$52K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,230 |
1,230 |
$41K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
452 |
302 |
$32K |
| D1110 |
Prophylaxis - adult |
710 |
710 |
$31K |
| D0140 |
Limited oral evaluation - problem focused |
870 |
861 |
$25K |
| D0330 |
Panoramic radiographic image |
656 |
656 |
$25K |
| D7140 |
Extraction, erupted tooth or exposed root |
213 |
141 |
$14K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
476 |
445 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
866 |
859 |
$9K |
| D2331 |
|
27 |
15 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
16 |
12 |
$1K |
| D0272 |
Bitewings - two radiographic images |
54 |
54 |
$1K |
| D2140 |
|
16 |
12 |
$872.05 |