| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
582 |
517 |
$27K |
| D0120 |
Periodic oral evaluation - established patient |
919 |
821 |
$20K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
142 |
95 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
409 |
330 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
195 |
180 |
$8K |
| D0274 |
Bitewings - four radiographic images |
198 |
191 |
$7K |
| D1206 |
Topical application of fluoride varnish |
278 |
261 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
134 |
127 |
$6K |
| D1120 |
Prophylaxis - child |
147 |
133 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
32 |
31 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
14 |
12 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
43 |
39 |
$576.98 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
16 |
13 |
$497.55 |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$314.76 |