| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,605 |
1,581 |
$76K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
571 |
262 |
$60K |
| D0120 |
Periodic oral evaluation - established patient |
1,966 |
1,935 |
$54K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,263 |
1,011 |
$46K |
| D1120 |
Prophylaxis - child |
1,313 |
1,291 |
$45K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,858 |
1,823 |
$38K |
| D0272 |
Bitewings - two radiographic images |
1,544 |
1,517 |
$34K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
49 |
41 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
289 |
283 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
632 |
625 |
$9K |
| D2950 |
|
51 |
42 |
$7K |
| D2931 |
|
34 |
27 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
522 |
422 |
$3K |
| D0330 |
Panoramic radiographic image |
25 |
25 |
$2K |
| D1999 |
|
40 |
39 |
$0.00 |