| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7880 |
|
111 |
81 |
$27K |
| D1110 |
Prophylaxis - adult |
544 |
490 |
$22K |
| D9630 |
|
1,267 |
1,003 |
$18K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
279 |
117 |
$17K |
| D0120 |
Periodic oral evaluation - established patient |
822 |
789 |
$15K |
| D1120 |
Prophylaxis - child |
395 |
395 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
516 |
514 |
$10K |
| D0274 |
Bitewings - four radiographic images |
349 |
325 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
122 |
54 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
228 |
157 |
$4K |
| D1206 |
Topical application of fluoride varnish |
129 |
129 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
422 |
45 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
309 |
200 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
38 |
15 |
$2K |
| D0330 |
Panoramic radiographic image |
54 |
40 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
49 |
39 |
$1K |
| D9310 |
|
16 |
13 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
129 |
41 |
$919.80 |
| D0140 |
Limited oral evaluation - problem focused |
13 |
12 |
$297.96 |