| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,000 |
1,917 |
$81K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,058 |
2,949 |
$58K |
| D0120 |
Periodic oral evaluation - established patient |
2,284 |
2,198 |
$53K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,828 |
1,189 |
$52K |
| D1120 |
Prophylaxis - child |
1,036 |
1,022 |
$34K |
| D0274 |
Bitewings - four radiographic images |
1,041 |
1,027 |
$27K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
337 |
231 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
733 |
693 |
$19K |
| D0210 |
Intraoral - complete series of radiographic images |
281 |
260 |
$15K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
142 |
94 |
$12K |
| D0330 |
Panoramic radiographic image |
185 |
183 |
$8K |
| D1351 |
Sealant - per tooth |
77 |
25 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
102 |
92 |
$1K |
| D0272 |
Bitewings - two radiographic images |
30 |
26 |
$463.25 |
| D1999 |
|
17 |
12 |
$0.00 |