| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,230 |
1,092 |
$39K |
| D1206 |
Topical application of fluoride varnish |
2,677 |
2,367 |
$37K |
| D0120 |
Periodic oral evaluation - established patient |
2,482 |
2,201 |
$36K |
| D1120 |
Prophylaxis - child |
1,508 |
1,335 |
$31K |
| D0274 |
Bitewings - four radiographic images |
482 |
428 |
$11K |
| D0330 |
Panoramic radiographic image |
192 |
175 |
$8K |
| D0272 |
Bitewings - two radiographic images |
441 |
398 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
336 |
228 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
97 |
58 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
85 |
41 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
54 |
36 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
31 |
27 |
$507.65 |