| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
681 |
669 |
$22K |
| D0330 |
Panoramic radiographic image |
333 |
329 |
$17K |
| D1110 |
Prophylaxis - adult |
272 |
268 |
$16K |
| D1120 |
Prophylaxis - child |
384 |
377 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
110 |
65 |
$11K |
| D0272 |
Bitewings - two radiographic images |
359 |
356 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
456 |
450 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
179 |
167 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
15 |
15 |
$961.95 |
| D1206 |
Topical application of fluoride varnish |
47 |
44 |
$777.28 |
| D0220 |
Intraoral - periapical first radiographic image |
20 |
12 |
$151.84 |