| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
470 |
424 |
$35K |
| D0120 |
Periodic oral evaluation - established patient |
781 |
729 |
$34K |
| D0274 |
Bitewings - four radiographic images |
587 |
533 |
$31K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
201 |
108 |
$28K |
| D0140 |
Limited oral evaluation - problem focused |
391 |
362 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
314 |
283 |
$18K |
| D4910 |
|
121 |
106 |
$11K |
| D1120 |
Prophylaxis - child |
163 |
155 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
288 |
265 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
313 |
294 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
81 |
76 |
$7K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
21 |
13 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
25 |
13 |
$2K |
| D0330 |
Panoramic radiographic image |
15 |
13 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
18 |
13 |
$912.16 |
| D0270 |
|
12 |
12 |
$293.16 |