| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
1,392 |
1,155 |
$47K |
| D0120 |
Periodic oral evaluation - established patient |
1,103 |
965 |
$25K |
| D1110 |
Prophylaxis - adult |
362 |
321 |
$17K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
498 |
423 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
467 |
394 |
$8K |
| D1120 |
Prophylaxis - child |
183 |
151 |
$5K |
| D0272 |
Bitewings - two radiographic images |
163 |
140 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
77 |
55 |
$3K |
| D0330 |
Panoramic radiographic image |
43 |
39 |
$3K |
| D1320 |
|
32 |
26 |
$897.40 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
30 |
24 |
$668.00 |