| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,180 |
2,101 |
$76K |
| D0120 |
Periodic oral evaluation - established patient |
3,632 |
3,542 |
$68K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,024 |
3,885 |
$58K |
| D1120 |
Prophylaxis - child |
1,327 |
1,289 |
$35K |
| D1999 |
|
1,649 |
1,488 |
$31K |
| D0274 |
Bitewings - four radiographic images |
1,205 |
1,138 |
$26K |
| D0330 |
Panoramic radiographic image |
512 |
484 |
$23K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
257 |
129 |
$16K |
| D0272 |
Bitewings - two radiographic images |
522 |
496 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
136 |
78 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
308 |
278 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
106 |
95 |
$3K |
| D1206 |
Topical application of fluoride varnish |
29 |
29 |
$420.00 |