| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,827 |
3,521 |
$96K |
| D1110 |
Prophylaxis - adult |
2,512 |
2,293 |
$81K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,948 |
5,450 |
$78K |
| D0120 |
Periodic oral evaluation - established patient |
4,470 |
4,128 |
$77K |
| D0330 |
Panoramic radiographic image |
1,309 |
1,202 |
$57K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,981 |
1,794 |
$42K |
| D0274 |
Bitewings - four radiographic images |
1,678 |
1,518 |
$34K |
| D0272 |
Bitewings - two radiographic images |
1,837 |
1,698 |
$29K |
| D1999 |
|
1,598 |
1,434 |
$29K |
| D0140 |
Limited oral evaluation - problem focused |
909 |
823 |
$23K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
247 |
150 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
224 |
131 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
329 |
292 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
13 |
12 |
$353.60 |
| D0145 |
Oral evaluation for a patient under three years of age |
14 |
14 |
$290.40 |