| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,721 |
2,449 |
$44K |
| D1120 |
Prophylaxis - child |
1,613 |
1,434 |
$38K |
| D1110 |
Prophylaxis - adult |
1,148 |
1,037 |
$37K |
| D0272 |
Bitewings - two radiographic images |
1,163 |
1,090 |
$19K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
623 |
492 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
511 |
435 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
56 |
26 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
120 |
70 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
27 |
13 |
$2K |
| D0330 |
Panoramic radiographic image |
14 |
12 |
$588.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
25 |
24 |
$564.00 |