| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,583 |
1,541 |
$74K |
| D0120 |
Periodic oral evaluation - established patient |
1,852 |
1,803 |
$50K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
327 |
184 |
$29K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,873 |
1,174 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
1,707 |
1,638 |
$24K |
| D1120 |
Prophylaxis - child |
322 |
318 |
$11K |
| D0272 |
Bitewings - two radiographic images |
481 |
478 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
473 |
465 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
220 |
206 |
$9K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
45 |
27 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
20 |
12 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
61 |
59 |
$2K |
| D0330 |
Panoramic radiographic image |
31 |
31 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
40 |
30 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
14 |
14 |
$770.51 |
| D1206 |
Topical application of fluoride varnish |
18 |
18 |
$591.84 |