| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,392 |
1,321 |
$48K |
| D1120 |
Prophylaxis - child |
1,334 |
1,254 |
$34K |
| D1206 |
Topical application of fluoride varnish |
1,113 |
1,047 |
$23K |
| D0330 |
Panoramic radiographic image |
310 |
302 |
$13K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
85 |
42 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
453 |
361 |
$9K |
| D0274 |
Bitewings - four radiographic images |
364 |
350 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
54 |
33 |
$4K |
| D0272 |
Bitewings - two radiographic images |
186 |
181 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
170 |
166 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
66 |
59 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
117 |
116 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
19 |
19 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
81 |
76 |
$827.10 |
| D1110 |
Prophylaxis - adult |
30 |
30 |
$130.00 |