| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
374 |
358 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
364 |
352 |
$9K |
| D1120 |
Prophylaxis - child |
237 |
227 |
$9K |
| D1206 |
Topical application of fluoride varnish |
295 |
284 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
293 |
274 |
$7K |
| D0330 |
Panoramic radiographic image |
135 |
130 |
$4K |
| D0274 |
Bitewings - four radiographic images |
257 |
245 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
123 |
118 |
$3K |
| D0272 |
Bitewings - two radiographic images |
85 |
80 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
369 |
350 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
17 |
12 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
16 |
16 |
$697.36 |
| D0270 |
|
13 |
13 |
$191.08 |
| D0431 |
|
85 |
77 |
$0.00 |
| D1330 |
|
127 |
119 |
$0.00 |