| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,112 |
2,082 |
$92K |
| D1206 |
Topical application of fluoride varnish |
3,010 |
2,964 |
$74K |
| D0120 |
Periodic oral evaluation - established patient |
1,972 |
1,945 |
$59K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
734 |
727 |
$39K |
| D1110 |
Prophylaxis - adult |
558 |
547 |
$34K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
214 |
106 |
$26K |
| D0330 |
Panoramic radiographic image |
413 |
410 |
$18K |
| D0272 |
Bitewings - two radiographic images |
910 |
891 |
$14K |
| D0274 |
Bitewings - four radiographic images |
153 |
147 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
29 |
29 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
14 |
13 |
$275.66 |
| D1330 |
|
17 |
16 |
$96.00 |