| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
666 |
620 |
$25K |
| D0120 |
Periodic oral evaluation - established patient |
911 |
826 |
$19K |
| D1120 |
Prophylaxis - child |
612 |
561 |
$17K |
| D1206 |
Topical application of fluoride varnish |
950 |
878 |
$17K |
| D0274 |
Bitewings - four radiographic images |
580 |
536 |
$12K |
| D0330 |
Panoramic radiographic image |
293 |
267 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
296 |
283 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
74 |
46 |
$4K |
| D0272 |
Bitewings - two radiographic images |
56 |
51 |
$814.26 |
| D0220 |
Intraoral - periapical first radiographic image |
42 |
38 |
$474.16 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
13 |
12 |
$354.48 |
| D0140 |
Limited oral evaluation - problem focused |
13 |
13 |
$317.20 |