| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,798 |
1,798 |
$89K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
767 |
409 |
$72K |
| D0120 |
Periodic oral evaluation - established patient |
2,410 |
2,410 |
$55K |
| D0274 |
Bitewings - four radiographic images |
1,865 |
1,865 |
$50K |
| D1206 |
Topical application of fluoride varnish |
2,981 |
2,981 |
$49K |
| D1120 |
Prophylaxis - child |
1,353 |
1,353 |
$47K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,180 |
1,180 |
$47K |
| D0220 |
Intraoral - periapical first radiographic image |
3,423 |
3,394 |
$43K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,115 |
2,904 |
$32K |
| D0330 |
Panoramic radiographic image |
443 |
443 |
$22K |
| D0272 |
Bitewings - two radiographic images |
1,022 |
1,022 |
$19K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
139 |
89 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
443 |
440 |
$16K |
| D7140 |
Extraction, erupted tooth or exposed root |
134 |
67 |
$10K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
96 |
90 |
$3K |
| D0240 |
|
226 |
226 |
$3K |
| D0160 |
|
19 |
19 |
$2K |
| D1351 |
Sealant - per tooth |
46 |
14 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
25 |
25 |
$1K |