| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
390 |
341 |
$29K |
| D0330 |
Panoramic radiographic image |
245 |
213 |
$20K |
| D0274 |
Bitewings - four radiographic images |
373 |
338 |
$20K |
| D0140 |
Limited oral evaluation - problem focused |
301 |
269 |
$17K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
101 |
45 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
596 |
543 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
217 |
195 |
$12K |
| D2740 |
Crown - porcelain/ceramic |
18 |
12 |
$9K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
18 |
14 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
400 |
355 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
102 |
93 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
17 |
13 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
34 |
19 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
25 |
21 |
$502.75 |
| D1999 |
|
18 |
17 |
$0.00 |