| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,023 |
3,782 |
$100K |
| D1120 |
Prophylaxis - child |
3,049 |
2,966 |
$79K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,382 |
3,199 |
$54K |
| D0272 |
Bitewings - two radiographic images |
1,764 |
1,666 |
$31K |
| D1110 |
Prophylaxis - adult |
580 |
566 |
$22K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
295 |
278 |
$12K |
| D1206 |
Topical application of fluoride varnish |
423 |
405 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
18 |
12 |
$2K |
| D0330 |
Panoramic radiographic image |
13 |
12 |
$681.45 |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$419.28 |
| D0220 |
Intraoral - periapical first radiographic image |
28 |
26 |
$405.60 |