| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,437 |
2,267 |
$110K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,611 |
1,006 |
$93K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,549 |
2,380 |
$64K |
| D1120 |
Prophylaxis - child |
1,184 |
1,096 |
$57K |
| D0330 |
Panoramic radiographic image |
1,483 |
1,367 |
$53K |
| D0274 |
Bitewings - four radiographic images |
1,989 |
1,862 |
$49K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
883 |
565 |
$37K |
| D0120 |
Periodic oral evaluation - established patient |
1,305 |
1,205 |
$26K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,693 |
1,552 |
$23K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
304 |
221 |
$20K |
| D1206 |
Topical application of fluoride varnish |
1,094 |
1,031 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
168 |
160 |
$9K |
| D1351 |
Sealant - per tooth |
376 |
109 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
203 |
191 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
274 |
244 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
425 |
397 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
239 |
114 |
$2K |
| D2332 |
|
17 |
12 |
$1K |
| D2331 |
|
20 |
12 |
$991.65 |
| D0272 |
Bitewings - two radiographic images |
32 |
29 |
$551.46 |