| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,771 |
2,135 |
$76K |
| D4212 |
|
213 |
77 |
$50K |
| D0120 |
Periodic oral evaluation - established patient |
3,203 |
2,437 |
$42K |
| D0274 |
Bitewings - four radiographic images |
1,845 |
1,368 |
$37K |
| D0140 |
Limited oral evaluation - problem focused |
1,381 |
923 |
$30K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
529 |
264 |
$25K |
| D0330 |
Panoramic radiographic image |
856 |
595 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,866 |
1,393 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
782 |
590 |
$14K |
| D1120 |
Prophylaxis - child |
908 |
680 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
687 |
441 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
1,611 |
1,145 |
$10K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,306 |
905 |
$9K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
45 |
14 |
$9K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
250 |
79 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
167 |
95 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
834 |
451 |
$4K |
| D0272 |
Bitewings - two radiographic images |
74 |
67 |
$49.62 |