| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
280 |
260 |
$13K |
| D0120 |
Periodic oral evaluation - established patient |
455 |
408 |
$11K |
| D1120 |
Prophylaxis - child |
299 |
286 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
90 |
45 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
613 |
564 |
$7K |
| D0274 |
Bitewings - four radiographic images |
201 |
187 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
621 |
532 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
317 |
298 |
$4K |
| D1206 |
Topical application of fluoride varnish |
309 |
292 |
$4K |
| D0272 |
Bitewings - two radiographic images |
118 |
108 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
19 |
17 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
66 |
64 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
15 |
13 |
$406.65 |
| D0603 |
|
351 |
338 |
$0.00 |
| D0601 |
|
179 |
174 |
$0.00 |
| D0602 |
|
14 |
14 |
$0.00 |