| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,236 |
4,062 |
$177K |
| D0120 |
Periodic oral evaluation - established patient |
6,850 |
6,639 |
$157K |
| D0274 |
Bitewings - four radiographic images |
4,933 |
4,746 |
$141K |
| D1120 |
Prophylaxis - child |
3,897 |
3,793 |
$120K |
| D1206 |
Topical application of fluoride varnish |
3,724 |
3,646 |
$76K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,227 |
3,097 |
$55K |
| D0330 |
Panoramic radiographic image |
560 |
534 |
$24K |
| D0272 |
Bitewings - two radiographic images |
1,141 |
1,113 |
$23K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
126 |
84 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
292 |
285 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
169 |
156 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
31 |
17 |
$2K |
| D1999 |
|
1,257 |
1,137 |
$0.00 |