| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,009 |
964 |
$47K |
| D0120 |
Periodic oral evaluation - established patient |
1,323 |
1,278 |
$36K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
355 |
149 |
$33K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,215 |
1,208 |
$24K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
196 |
82 |
$22K |
| D0272 |
Bitewings - two radiographic images |
974 |
966 |
$21K |
| D0330 |
Panoramic radiographic image |
489 |
480 |
$20K |
| D1120 |
Prophylaxis - child |
345 |
345 |
$11K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
198 |
187 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
127 |
127 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
547 |
518 |
$5K |
| D1206 |
Topical application of fluoride varnish |
160 |
159 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
158 |
136 |
$1K |