| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,116 |
1,096 |
$76K |
| D0120 |
Periodic oral evaluation - established patient |
1,826 |
1,805 |
$57K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
329 |
185 |
$35K |
| D1120 |
Prophylaxis - child |
771 |
760 |
$34K |
| D0274 |
Bitewings - four radiographic images |
749 |
738 |
$26K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,025 |
1,010 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
1,662 |
1,525 |
$22K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
156 |
102 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
987 |
930 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
170 |
170 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
93 |
93 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
163 |
149 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
98 |
94 |
$4K |
| D0272 |
Bitewings - two radiographic images |
85 |
85 |
$2K |
| D1330 |
|
186 |
186 |
$1K |
| D1206 |
Topical application of fluoride varnish |
13 |
13 |
$323.96 |