| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
259 |
194 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
174 |
143 |
$8K |
| D1206 |
Topical application of fluoride varnish |
404 |
309 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
98 |
64 |
$7K |
| D0120 |
Periodic oral evaluation - established patient |
328 |
246 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
173 |
137 |
$4K |
| D1120 |
Prophylaxis - child |
108 |
87 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
65 |
35 |
$3K |
| D0274 |
Bitewings - four radiographic images |
130 |
95 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
223 |
168 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
75 |
63 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
17 |
12 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
164 |
121 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
47 |
37 |
$849.00 |
| D4346 |
|
19 |
13 |
$579.12 |