| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,028 |
3,883 |
$111K |
| D0120 |
Periodic oral evaluation - established patient |
5,028 |
4,847 |
$95K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,138 |
698 |
$78K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,517 |
4,325 |
$64K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,976 |
1,732 |
$39K |
| D1110 |
Prophylaxis - adult |
686 |
654 |
$24K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
380 |
243 |
$23K |
| D0272 |
Bitewings - two radiographic images |
1,308 |
1,259 |
$22K |
| D1999 |
|
1,218 |
1,077 |
$20K |
| D0330 |
Panoramic radiographic image |
405 |
385 |
$17K |
| D0274 |
Bitewings - four radiographic images |
93 |
91 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
74 |
64 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
45 |
40 |
$998.00 |