| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,560 |
3,494 |
$173K |
| D0120 |
Periodic oral evaluation - established patient |
5,088 |
5,010 |
$144K |
| D1120 |
Prophylaxis - child |
2,398 |
2,367 |
$84K |
| D0272 |
Bitewings - two radiographic images |
3,481 |
3,440 |
$75K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,458 |
3,425 |
$70K |
| D2140 |
|
819 |
500 |
$53K |
| D0220 |
Intraoral - periapical first radiographic image |
2,354 |
2,268 |
$34K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
449 |
297 |
$34K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
722 |
705 |
$33K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
213 |
152 |
$26K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
204 |
153 |
$19K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
375 |
351 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
101 |
92 |
$1K |
| D7111 |
|
17 |
13 |
$1K |
| D0330 |
Panoramic radiographic image |
17 |
17 |
$890.93 |
| D0140 |
Limited oral evaluation - problem focused |
14 |
14 |
$210.00 |