| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
625 |
615 |
$34K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
257 |
162 |
$30K |
| D0120 |
Periodic oral evaluation - established patient |
491 |
483 |
$16K |
| D0330 |
Panoramic radiographic image |
180 |
178 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
169 |
167 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
183 |
177 |
$4K |
| D0272 |
Bitewings - two radiographic images |
93 |
93 |
$2K |
| D1120 |
Prophylaxis - child |
55 |
55 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
47 |
45 |
$2K |
| D1206 |
Topical application of fluoride varnish |
27 |
27 |
$887.76 |
| D0220 |
Intraoral - periapical first radiographic image |
25 |
25 |
$337.87 |
| D9986 |
|
59 |
54 |
$0.00 |