| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,904 |
2,870 |
$49K |
| D1206 |
Topical application of fluoride varnish |
2,317 |
2,301 |
$45K |
| D1120 |
Prophylaxis - child |
1,141 |
1,132 |
$38K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
280 |
155 |
$30K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
292 |
131 |
$28K |
| D0210 |
Intraoral - complete series of radiographic images |
521 |
430 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
591 |
562 |
$17K |
| D0274 |
Bitewings - four radiographic images |
729 |
714 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
1,721 |
1,549 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
149 |
55 |
$12K |
| D4346 |
|
249 |
249 |
$12K |
| D9920 |
|
131 |
122 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
913 |
619 |
$7K |
| D1110 |
Prophylaxis - adult |
169 |
169 |
$6K |
| D4910 |
|
312 |
304 |
$6K |
| D2394 |
|
40 |
24 |
$5K |
| D2950 |
|
26 |
14 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
77 |
65 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
27 |
13 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
179 |
162 |
$2K |
| D0372 |
|
13 |
13 |
$1K |
| D0374 |
|
22 |
17 |
$159.83 |