| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,449 |
3,333 |
$79K |
| D1110 |
Prophylaxis - adult |
1,762 |
1,692 |
$70K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,865 |
2,789 |
$55K |
| D1120 |
Prophylaxis - child |
1,660 |
1,626 |
$54K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
720 |
365 |
$42K |
| D0330 |
Panoramic radiographic image |
687 |
654 |
$29K |
| D0274 |
Bitewings - four radiographic images |
981 |
945 |
$23K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
298 |
174 |
$20K |
| D0272 |
Bitewings - two radiographic images |
793 |
779 |
$13K |
| D9110 |
|
223 |
204 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
163 |
148 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
77 |
68 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
57 |
49 |
$614.88 |
| D1999 |
|
28 |
27 |
$0.00 |