| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
7,028 |
6,733 |
$315K |
| D0330 |
Panoramic radiographic image |
3,008 |
2,890 |
$133K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,259 |
774 |
$113K |
| D0272 |
Bitewings - two radiographic images |
5,650 |
5,438 |
$96K |
| D0120 |
Periodic oral evaluation - established patient |
3,273 |
3,137 |
$83K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,067 |
1,022 |
$47K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,401 |
1,347 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
1,366 |
1,280 |
$13K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
75 |
50 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
41 |
39 |
$2K |
| D1120 |
Prophylaxis - child |
50 |
48 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
28 |
25 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
229 |
104 |
$589.47 |
| D0140 |
Limited oral evaluation - problem focused |
24 |
24 |
$345.00 |