| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1208 |
Topical application of fluoride, excluding varnish |
5,378 |
5,265 |
$111K |
| D1110 |
Prophylaxis - adult |
2,255 |
2,196 |
$94K |
| D0120 |
Periodic oral evaluation - established patient |
3,818 |
3,728 |
$90K |
| D1120 |
Prophylaxis - child |
1,621 |
1,587 |
$54K |
| D0272 |
Bitewings - two radiographic images |
2,529 |
2,491 |
$42K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
871 |
849 |
$24K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
468 |
413 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
71 |
48 |
$5K |
| D0274 |
Bitewings - four radiographic images |
115 |
113 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
39 |
30 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
140 |
134 |
$2K |