| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,367 |
2,349 |
$131K |
| D0274 |
Bitewings - four radiographic images |
2,299 |
2,278 |
$90K |
| D0330 |
Panoramic radiographic image |
932 |
924 |
$73K |
| D1206 |
Topical application of fluoride varnish |
2,845 |
2,828 |
$73K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,913 |
1,899 |
$69K |
| D0120 |
Periodic oral evaluation - established patient |
1,956 |
1,942 |
$64K |
| D1120 |
Prophylaxis - child |
958 |
953 |
$40K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
358 |
224 |
$21K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
249 |
160 |
$20K |
| D1351 |
Sealant - per tooth |
541 |
158 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
525 |
515 |
$10K |
| D0272 |
Bitewings - two radiographic images |
229 |
228 |
$9K |
| D2140 |
|
140 |
79 |
$8K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
117 |
83 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
74 |
74 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
446 |
175 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
191 |
188 |
$5K |
| D4341 |
|
22 |
12 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
13 |
12 |
$244.76 |