| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0274 |
Bitewings - four radiographic images |
1,403 |
1,358 |
$38K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
527 |
264 |
$32K |
| D1120 |
Prophylaxis - child |
915 |
881 |
$23K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
280 |
155 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,074 |
1,504 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,713 |
1,640 |
$19K |
| D1208 |
Topical application of fluoride, excluding varnish |
899 |
864 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
409 |
386 |
$14K |
| D0120 |
Periodic oral evaluation - established patient |
658 |
642 |
$13K |
| D1110 |
Prophylaxis - adult |
125 |
120 |
$5K |
| D8660 |
|
53 |
50 |
$4K |
| D0330 |
Panoramic radiographic image |
16 |
13 |
$696.37 |
| D0340 |
|
16 |
13 |
$562.90 |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$351.34 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
12 |
12 |
$342.00 |
| D1206 |
Topical application of fluoride varnish |
12 |
12 |
$253.55 |