| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,425 |
1,328 |
$56K |
| D0120 |
Periodic oral evaluation - established patient |
1,898 |
1,791 |
$36K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
475 |
299 |
$34K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,171 |
1,099 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
572 |
537 |
$15K |
| D0274 |
Bitewings - four radiographic images |
514 |
489 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
249 |
153 |
$15K |
| D1120 |
Prophylaxis - child |
503 |
481 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
384 |
352 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
880 |
803 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
41 |
26 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
41 |
38 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
32 |
28 |
$901.90 |
| D2140 |
|
21 |
14 |
$0.00 |