| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,514 |
1,499 |
$57K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,024 |
1,014 |
$56K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
771 |
494 |
$49K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,654 |
2,492 |
$44K |
| D0120 |
Periodic oral evaluation - established patient |
687 |
687 |
$44K |
| D0350 |
|
4,207 |
1,253 |
$40K |
| D1110 |
Prophylaxis - adult |
375 |
375 |
$33K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
859 |
766 |
$33K |
| D1206 |
Topical application of fluoride varnish |
2,003 |
1,989 |
$30K |
| D0210 |
Intraoral - complete series of radiographic images |
567 |
567 |
$27K |
| D2740 |
Crown - porcelain/ceramic |
54 |
41 |
$26K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
276 |
164 |
$14K |
| D1320 |
|
605 |
600 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
727 |
686 |
$8K |
| D0274 |
Bitewings - four radiographic images |
295 |
295 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
77 |
57 |
$6K |
| D4910 |
|
38 |
38 |
$3K |
| D9430 |
|
87 |
83 |
$3K |
| D0272 |
Bitewings - two radiographic images |
158 |
158 |
$2K |
| D4342 |
|
29 |
13 |
$1K |
| D0330 |
Panoramic radiographic image |
32 |
32 |
$960.00 |
| D1999 |
|
1,595 |
1,508 |
$895.00 |
| D0270 |
|
13 |
13 |
$65.00 |
| D9993 |
|
48 |
48 |
$0.00 |
| D1310 |
|
48 |
48 |
$0.00 |
| D0603 |
|
47 |
47 |
$0.00 |