| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,528 |
1,477 |
$31K |
| D1110 |
Prophylaxis - adult |
604 |
591 |
$26K |
| D1120 |
Prophylaxis - child |
508 |
496 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
839 |
808 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
57 |
37 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
411 |
399 |
$6K |
| D0274 |
Bitewings - four radiographic images |
171 |
161 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
153 |
146 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
65 |
39 |
$3K |
| D1206 |
Topical application of fluoride varnish |
93 |
93 |
$1K |
| D0330 |
Panoramic radiographic image |
27 |
27 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$368.96 |
| D0230 |
Intraoral - periapical each additional radiographic image |
36 |
14 |
$274.32 |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$239.62 |
| D0601 |
|
17 |
17 |
$155.55 |