| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,455 |
2,364 |
$101K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,546 |
946 |
$85K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,995 |
2,913 |
$74K |
| D0330 |
Panoramic radiographic image |
1,718 |
1,660 |
$60K |
| D0274 |
Bitewings - four radiographic images |
2,467 |
2,377 |
$56K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
631 |
447 |
$40K |
| D1120 |
Prophylaxis - child |
651 |
637 |
$28K |
| D0120 |
Periodic oral evaluation - established patient |
946 |
901 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,334 |
1,301 |
$20K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
199 |
152 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
1,098 |
1,049 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
206 |
192 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
178 |
165 |
$5K |
| D9110 |
|
177 |
173 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
96 |
51 |
$3K |
| D0180 |
|
48 |
48 |
$3K |
| D0272 |
Bitewings - two radiographic images |
211 |
206 |
$3K |
| D1206 |
Topical application of fluoride varnish |
193 |
176 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
422 |
238 |
$2K |
| D2331 |
|
40 |
30 |
$2K |
| D2332 |
|
29 |
24 |
$2K |
| D9986 |
|
577 |
549 |
$2K |
| D9987 |
|
57 |
53 |
$150.00 |