| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
804 |
736 |
$38K |
| D0274 |
Bitewings - four radiographic images |
488 |
448 |
$18K |
| D0120 |
Periodic oral evaluation - established patient |
785 |
741 |
$17K |
| D1206 |
Topical application of fluoride varnish |
762 |
692 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
145 |
97 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
231 |
183 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
571 |
491 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
181 |
138 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
74 |
69 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
18 |
13 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
24 |
24 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
14 |
12 |
$899.60 |
| D1120 |
Prophylaxis - child |
33 |
27 |
$586.50 |