| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,754 |
4,257 |
$166K |
| D0330 |
Panoramic radiographic image |
2,348 |
2,031 |
$115K |
| D0274 |
Bitewings - four radiographic images |
3,309 |
2,932 |
$95K |
| D0120 |
Periodic oral evaluation - established patient |
4,126 |
3,722 |
$90K |
| D0220 |
Intraoral - periapical first radiographic image |
5,704 |
4,921 |
$77K |
| D0140 |
Limited oral evaluation - problem focused |
2,315 |
1,961 |
$71K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
676 |
399 |
$63K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,735 |
3,605 |
$52K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,222 |
1,051 |
$46K |
| D4341 |
|
265 |
87 |
$20K |
| D1206 |
Topical application of fluoride varnish |
1,389 |
1,092 |
$18K |
| D5110 |
|
29 |
26 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
176 |
127 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
327 |
318 |
$5K |
| D4342 |
|
53 |
26 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
22 |
13 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
109 |
42 |
$2K |
| D1120 |
Prophylaxis - child |
47 |
42 |
$1K |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$212.85 |