| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,716 |
3,660 |
$197K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,303 |
594 |
$128K |
| D0274 |
Bitewings - four radiographic images |
2,542 |
2,499 |
$79K |
| D0210 |
Intraoral - complete series of radiographic images |
1,084 |
1,067 |
$74K |
| D0120 |
Periodic oral evaluation - established patient |
2,466 |
2,430 |
$69K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
785 |
389 |
$60K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,675 |
3,622 |
$53K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,060 |
1,035 |
$36K |
| D0220 |
Intraoral - periapical first radiographic image |
2,788 |
2,738 |
$32K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,966 |
2,559 |
$29K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
27 |
14 |
$3K |
| D0330 |
Panoramic radiographic image |
300 |
295 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
14 |
14 |
$352.43 |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$238.83 |
| D0602 |
|
883 |
872 |
$0.00 |
| D0603 |
|
1,916 |
1,889 |
$0.00 |
| D0601 |
|
761 |
751 |
$0.00 |