| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,029 |
1,029 |
$51K |
| D0330 |
Panoramic radiographic image |
496 |
496 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
583 |
583 |
$23K |
| D0120 |
Periodic oral evaluation - established patient |
784 |
784 |
$18K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
166 |
126 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
945 |
945 |
$15K |
| D0274 |
Bitewings - four radiographic images |
481 |
481 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
1,072 |
1,053 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
237 |
236 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
48 |
36 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
559 |
536 |
$5K |
| D1120 |
Prophylaxis - child |
149 |
149 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
129 |
109 |
$4K |
| D0272 |
Bitewings - two radiographic images |
221 |
221 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
37 |
25 |
$3K |