| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,402 |
2,391 |
$195K |
| D0274 |
Bitewings - four radiographic images |
4,568 |
3,236 |
$183K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
821 |
371 |
$107K |
| D0120 |
Periodic oral evaluation - established patient |
2,882 |
2,145 |
$92K |
| D0140 |
Limited oral evaluation - problem focused |
1,482 |
1,267 |
$80K |
| D0330 |
Panoramic radiographic image |
1,025 |
808 |
$74K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,517 |
991 |
$61K |
| D2740 |
Crown - porcelain/ceramic |
152 |
74 |
$53K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,995 |
1,339 |
$37K |
| D0220 |
Intraoral - periapical first radiographic image |
1,699 |
1,268 |
$32K |
| D9211 |
|
301 |
160 |
$19K |
| D2950 |
|
137 |
76 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
107 |
55 |
$14K |
| D1120 |
Prophylaxis - child |
226 |
210 |
$13K |
| D1206 |
Topical application of fluoride varnish |
316 |
292 |
$8K |
| D1351 |
Sealant - per tooth |
128 |
14 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
25 |
12 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
17 |
13 |
$812.40 |