| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,561 |
1,482 |
$27K |
| D1110 |
Prophylaxis - adult |
716 |
685 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,450 |
1,387 |
$20K |
| D1120 |
Prophylaxis - child |
1,018 |
975 |
$20K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
247 |
143 |
$13K |
| D0330 |
Panoramic radiographic image |
146 |
141 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
80 |
44 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
156 |
151 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
270 |
241 |
$1K |
| D0274 |
Bitewings - four radiographic images |
68 |
54 |
$966.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
154 |
129 |
$708.75 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
16 |
14 |
$420.70 |
| D0140 |
Limited oral evaluation - problem focused |
14 |
13 |
$278.52 |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$136.50 |