| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1206 |
Topical application of fluoride varnish |
4,093 |
3,946 |
$91K |
| D0120 |
Periodic oral evaluation - established patient |
3,081 |
3,027 |
$79K |
| D1110 |
Prophylaxis - adult |
1,077 |
1,050 |
$55K |
| D1120 |
Prophylaxis - child |
1,344 |
1,319 |
$49K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
336 |
186 |
$45K |
| D0140 |
Limited oral evaluation - problem focused |
764 |
647 |
$26K |
| D0274 |
Bitewings - four radiographic images |
748 |
729 |
$25K |
| D0350 |
|
524 |
508 |
$16K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
189 |
92 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
388 |
365 |
$6K |
| D0330 |
Panoramic radiographic image |
84 |
84 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
17 |
12 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
105 |
89 |
$3K |
| D0272 |
Bitewings - two radiographic images |
123 |
122 |
$3K |
| D9110 |
|
28 |
26 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
26 |
26 |
$1K |
| D9920 |
|
14 |
12 |
$742.12 |