| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,103 |
1,001 |
$51K |
| D0120 |
Periodic oral evaluation - established patient |
1,961 |
1,808 |
$43K |
| D1206 |
Topical application of fluoride varnish |
1,859 |
1,691 |
$36K |
| D1120 |
Prophylaxis - child |
1,189 |
1,092 |
$35K |
| D0274 |
Bitewings - four radiographic images |
1,048 |
925 |
$32K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
438 |
373 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
196 |
177 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
241 |
188 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
78 |
42 |
$6K |
| D0330 |
Panoramic radiographic image |
80 |
62 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
14 |
14 |
$378.21 |
| D1999 |
|
189 |
165 |
$160.00 |