| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,470 |
4,450 |
$103K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,257 |
1,173 |
$103K |
| D0120 |
Periodic oral evaluation - established patient |
4,238 |
4,221 |
$98K |
| D0210 |
Intraoral - complete series of radiographic images |
1,903 |
1,897 |
$66K |
| D2750 |
|
143 |
115 |
$64K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,455 |
707 |
$59K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,790 |
4,765 |
$56K |
| D1120 |
Prophylaxis - child |
1,937 |
1,930 |
$52K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,209 |
2,200 |
$50K |
| D0274 |
Bitewings - four radiographic images |
3,499 |
3,480 |
$44K |
| D0140 |
Limited oral evaluation - problem focused |
1,655 |
1,569 |
$36K |
| D1351 |
Sealant - per tooth |
1,494 |
306 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
5,528 |
5,406 |
$26K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,103 |
5,016 |
$20K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
178 |
136 |
$9K |
| D1353 |
|
423 |
57 |
$4K |
| D0601 |
|
340 |
340 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
163 |
151 |
$2K |
| D0602 |
|
263 |
263 |
$2K |
| D9920 |
|
97 |
82 |
$2K |
| D2335 |
|
26 |
14 |
$2K |
| D4355 |
|
12 |
12 |
$720.00 |