| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
276 |
267 |
$14K |
| D0274 |
Bitewings - four radiographic images |
310 |
291 |
$9K |
| D1206 |
Topical application of fluoride varnish |
406 |
393 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
161 |
154 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
198 |
190 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
444 |
425 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
415 |
384 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
29 |
12 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
26 |
25 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
13 |
12 |
$351.94 |
| D0602 |
|
244 |
240 |
$33.00 |
| D0603 |
|
122 |
114 |
$0.00 |