| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7962 |
|
951 |
907 |
$236K |
| D7961 |
|
858 |
819 |
$209K |
| D7960 |
|
1,766 |
838 |
$208K |
| D0140 |
Limited oral evaluation - problem focused |
3,593 |
3,064 |
$97K |
| D1110 |
Prophylaxis - adult |
2,071 |
1,972 |
$89K |
| D0120 |
Periodic oral evaluation - established patient |
3,764 |
3,590 |
$79K |
| D1120 |
Prophylaxis - child |
2,217 |
2,101 |
$65K |
| D1206 |
Topical application of fluoride varnish |
2,530 |
2,372 |
$47K |
| D0274 |
Bitewings - four radiographic images |
790 |
754 |
$27K |
| D0210 |
Intraoral - complete series of radiographic images |
390 |
361 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
717 |
671 |
$20K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
261 |
162 |
$17K |
| D0272 |
Bitewings - two radiographic images |
290 |
278 |
$7K |
| D9996 |
|
1,447 |
1,155 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
63 |
42 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
202 |
190 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
41 |
37 |
$1K |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$738.13 |
| D1999 |
|
807 |
709 |
$180.00 |