| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0220 |
Intraoral - periapical first radiographic image |
940 |
772 |
$22K |
| D1110 |
Prophylaxis - adult |
239 |
217 |
$19K |
| D0330 |
Panoramic radiographic image |
197 |
175 |
$16K |
| D0274 |
Bitewings - four radiographic images |
298 |
272 |
$16K |
| D0120 |
Periodic oral evaluation - established patient |
258 |
237 |
$11K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
165 |
133 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
49 |
15 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
78 |
69 |
$5K |
| D2332 |
|
32 |
16 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
36 |
16 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
64 |
45 |
$2K |
| D4910 |
|
16 |
15 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
31 |
29 |
$762.32 |