| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
489 |
440 |
$34K |
| D1110 |
Prophylaxis - adult |
677 |
623 |
$33K |
| D0120 |
Periodic oral evaluation - established patient |
1,118 |
1,000 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
626 |
550 |
$22K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
252 |
132 |
$17K |
| D1120 |
Prophylaxis - child |
368 |
343 |
$12K |
| D0274 |
Bitewings - four radiographic images |
435 |
390 |
$9K |
| D1206 |
Topical application of fluoride varnish |
426 |
382 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
741 |
621 |
$7K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
34 |
12 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
82 |
38 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
135 |
111 |
$5K |
| D2394 |
|
50 |
24 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
102 |
100 |
$2K |
| D0330 |
Panoramic radiographic image |
170 |
155 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
483 |
156 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
18 |
13 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
18 |
12 |
$433.30 |