| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,825 |
1,825 |
$87K |
| D0274 |
Bitewings - four radiographic images |
1,885 |
1,885 |
$49K |
| D0120 |
Periodic oral evaluation - established patient |
2,005 |
2,005 |
$43K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,535 |
1,535 |
$24K |
| D0330 |
Panoramic radiographic image |
537 |
537 |
$24K |
| D1120 |
Prophylaxis - child |
509 |
509 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
432 |
432 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
1,313 |
1,222 |
$15K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
127 |
77 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
366 |
355 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
70 |
50 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
142 |
133 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
40 |
26 |
$3K |
| D0272 |
Bitewings - two radiographic images |
134 |
134 |
$3K |
| D2394 |
|
14 |
12 |
$2K |
| D2160 |
|
16 |
12 |
$1K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
18 |
12 |
$1K |
| D2161 |
|
17 |
14 |
$1K |
| D1206 |
Topical application of fluoride varnish |
12 |
12 |
$194.40 |
| D0230 |
Intraoral - periapical each additional radiographic image |
15 |
13 |
$128.27 |