| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
489 |
489 |
$32K |
| D1110 |
Prophylaxis - adult |
387 |
387 |
$23K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
312 |
250 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
590 |
583 |
$18K |
| D0274 |
Bitewings - four radiographic images |
479 |
479 |
$15K |
| D1120 |
Prophylaxis - child |
372 |
342 |
$15K |
| D0120 |
Periodic oral evaluation - established patient |
314 |
296 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
148 |
114 |
$8K |
| D1206 |
Topical application of fluoride varnish |
355 |
341 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
91 |
75 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
142 |
139 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
101 |
87 |
$2K |
| D2331 |
|
30 |
27 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
190 |
188 |
$2K |
| D1351 |
Sealant - per tooth |
38 |
13 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
31 |
30 |
$1K |
| D0272 |
Bitewings - two radiographic images |
129 |
120 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
118 |
64 |
$903.55 |
| D0210 |
Intraoral - complete series of radiographic images |
31 |
31 |
$472.30 |