| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,315 |
1,301 |
$57K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,020 |
993 |
$30K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,107 |
1,099 |
$24K |
| D0274 |
Bitewings - four radiographic images |
908 |
884 |
$24K |
| D0120 |
Periodic oral evaluation - established patient |
729 |
727 |
$19K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
216 |
173 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
228 |
190 |
$15K |
| D1120 |
Prophylaxis - child |
361 |
359 |
$13K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
299 |
272 |
$9K |
| D2950 |
|
46 |
40 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
289 |
273 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
27 |
27 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
54 |
52 |
$1K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
15 |
12 |
$1K |
| D2140 |
|
16 |
13 |
$1K |
| D0272 |
Bitewings - two radiographic images |
58 |
57 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
20 |
13 |
$182.44 |