| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,838 |
4,745 |
$167K |
| D0120 |
Periodic oral evaluation - established patient |
5,053 |
4,960 |
$121K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,510 |
5,412 |
$98K |
| D0272 |
Bitewings - two radiographic images |
3,790 |
3,726 |
$81K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,077 |
1,011 |
$32K |
| D1110 |
Prophylaxis - adult |
385 |
378 |
$18K |
| D0330 |
Panoramic radiographic image |
253 |
244 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
365 |
355 |
$14K |
| D0274 |
Bitewings - four radiographic images |
273 |
272 |
$8K |
| D1354 |
|
173 |
46 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
41 |
26 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
46 |
38 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$374.00 |