| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,117 |
1,023 |
$58K |
| D1354 |
|
935 |
168 |
$50K |
| D0120 |
Periodic oral evaluation - established patient |
1,873 |
1,679 |
$46K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,979 |
1,743 |
$41K |
| D0274 |
Bitewings - four radiographic images |
908 |
805 |
$31K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
264 |
173 |
$30K |
| D1120 |
Prophylaxis - child |
758 |
696 |
$28K |
| D0140 |
Limited oral evaluation - problem focused |
553 |
491 |
$19K |
| D0330 |
Panoramic radiographic image |
190 |
175 |
$11K |
| D1320 |
|
429 |
408 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
59 |
44 |
$6K |
| D1351 |
Sealant - per tooth |
197 |
48 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
383 |
352 |
$6K |
| D9630 |
|
204 |
195 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
40 |
38 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
21 |
12 |
$2K |
| D0272 |
Bitewings - two radiographic images |
68 |
62 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
39 |
37 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
14 |
13 |
$616.00 |