| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,331 |
2,217 |
$60K |
| D0120 |
Periodic oral evaluation - established patient |
3,262 |
3,104 |
$55K |
| D1110 |
Prophylaxis - adult |
1,261 |
1,199 |
$41K |
| D1206 |
Topical application of fluoride varnish |
1,155 |
1,098 |
$26K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,786 |
1,700 |
$24K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
966 |
868 |
$20K |
| D0272 |
Bitewings - two radiographic images |
644 |
611 |
$11K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
139 |
100 |
$11K |
| D0330 |
Panoramic radiographic image |
240 |
229 |
$10K |
| D0274 |
Bitewings - four radiographic images |
307 |
293 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
86 |
65 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
272 |
252 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
111 |
106 |
$3K |
| D1354 |
|
37 |
14 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
91 |
88 |
$981.75 |