| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,441 |
1,360 |
$66K |
| D0140 |
Limited oral evaluation - problem focused |
900 |
687 |
$24K |
| D9110 |
|
598 |
473 |
$19K |
| D0210 |
Intraoral - complete series of radiographic images |
276 |
263 |
$18K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,247 |
851 |
$15K |
| D0120 |
Periodic oral evaluation - established patient |
713 |
670 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
248 |
76 |
$11K |
| D0274 |
Bitewings - four radiographic images |
360 |
329 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
665 |
598 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
238 |
224 |
$8K |
| D2394 |
|
43 |
26 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
125 |
62 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
30 |
30 |
$435.00 |
| D0180 |
|
14 |
12 |
$354.00 |