| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,134 |
2,072 |
$88K |
| D0120 |
Periodic oral evaluation - established patient |
2,334 |
2,273 |
$55K |
| D1206 |
Topical application of fluoride varnish |
2,123 |
2,069 |
$45K |
| D1120 |
Prophylaxis - child |
1,212 |
1,185 |
$39K |
| D0274 |
Bitewings - four radiographic images |
1,423 |
1,392 |
$35K |
| D7140 |
Extraction, erupted tooth or exposed root |
301 |
86 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
739 |
727 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
973 |
967 |
$19K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
204 |
119 |
$14K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
432 |
387 |
$12K |
| D0330 |
Panoramic radiographic image |
266 |
258 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
111 |
81 |
$6K |
| D0272 |
Bitewings - two radiographic images |
394 |
392 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
372 |
349 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
68 |
67 |
$1K |
| D1999 |
|
451 |
426 |
$0.00 |