| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
944 |
890 |
$44K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
368 |
126 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,025 |
932 |
$31K |
| D0274 |
Bitewings - four radiographic images |
1,207 |
1,131 |
$23K |
| D0120 |
Periodic oral evaluation - established patient |
843 |
800 |
$22K |
| D0330 |
Panoramic radiographic image |
1,058 |
983 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,238 |
1,206 |
$18K |
| D0145 |
Oral evaluation for a patient under three years of age |
123 |
122 |
$17K |
| D0210 |
Intraoral - complete series of radiographic images |
240 |
233 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
2,042 |
1,923 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,503 |
1,695 |
$14K |
| D1120 |
Prophylaxis - child |
364 |
353 |
$12K |
| D0350 |
|
685 |
627 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
145 |
131 |
$4K |
| D0272 |
Bitewings - two radiographic images |
186 |
180 |
$3K |
| D1351 |
Sealant - per tooth |
66 |
13 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
23 |
12 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
29 |
28 |
$736.79 |
| D0603 |
|
1,588 |
1,538 |
$552.48 |
| D0602 |
|
203 |
193 |
$79.10 |
| D0601 |
|
48 |
47 |
$5.00 |