| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,272 |
3,190 |
$163K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
818 |
513 |
$60K |
| D0120 |
Periodic oral evaluation - established patient |
2,190 |
2,123 |
$48K |
| D1120 |
Prophylaxis - child |
1,123 |
1,076 |
$38K |
| D0274 |
Bitewings - four radiographic images |
1,064 |
1,039 |
$37K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
779 |
755 |
$29K |
| D1206 |
Topical application of fluoride varnish |
1,230 |
1,185 |
$27K |
| D0140 |
Limited oral evaluation - problem focused |
600 |
591 |
$23K |
| D0210 |
Intraoral - complete series of radiographic images |
331 |
305 |
$22K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
213 |
151 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
881 |
848 |
$17K |
| D0330 |
Panoramic radiographic image |
248 |
235 |
$15K |
| D1351 |
Sealant - per tooth |
507 |
104 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
105 |
84 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
31 |
27 |
$925.40 |
| D0220 |
Intraoral - periapical first radiographic image |
52 |
51 |
$626.85 |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$295.72 |
| D1999 |
|
120 |
103 |
$80.00 |