| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,288 |
2,187 |
$79K |
| D0120 |
Periodic oral evaluation - established patient |
3,987 |
3,809 |
$68K |
| D1120 |
Prophylaxis - child |
2,053 |
1,961 |
$53K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
571 |
309 |
$37K |
| D0274 |
Bitewings - four radiographic images |
1,590 |
1,519 |
$35K |
| D1206 |
Topical application of fluoride varnish |
1,759 |
1,679 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
719 |
703 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
636 |
603 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
206 |
134 |
$11K |
| D0272 |
Bitewings - two radiographic images |
601 |
584 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
928 |
890 |
$9K |
| D2740 |
Crown - porcelain/ceramic |
15 |
12 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
77 |
49 |
$4K |
| D0330 |
Panoramic radiographic image |
77 |
73 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
96 |
83 |
$2K |
| D2331 |
|
16 |
13 |
$941.86 |