| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,085 |
1,709 |
$143K |
| D0274 |
Bitewings - four radiographic images |
1,695 |
1,417 |
$82K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
573 |
216 |
$75K |
| D0330 |
Panoramic radiographic image |
821 |
671 |
$63K |
| D0120 |
Periodic oral evaluation - established patient |
1,057 |
907 |
$41K |
| D0140 |
Limited oral evaluation - problem focused |
652 |
566 |
$36K |
| D2740 |
Crown - porcelain/ceramic |
67 |
38 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
585 |
468 |
$30K |
| D0220 |
Intraoral - periapical first radiographic image |
1,424 |
1,229 |
$29K |
| D1120 |
Prophylaxis - child |
355 |
316 |
$20K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
315 |
256 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
111 |
60 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
435 |
385 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
274 |
152 |
$7K |
| D1206 |
Topical application of fluoride varnish |
143 |
137 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
19 |
12 |
$3K |
| D2950 |
|
17 |
14 |
$3K |
| D4910 |
|
14 |
12 |
$975.95 |
| D0272 |
Bitewings - two radiographic images |
18 |
17 |
$692.24 |