| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
760 |
718 |
$38K |
| D0120 |
Periodic oral evaluation - established patient |
1,150 |
1,077 |
$30K |
| D0274 |
Bitewings - four radiographic images |
843 |
785 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,314 |
1,220 |
$17K |
| D1120 |
Prophylaxis - child |
276 |
257 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
359 |
334 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
39 |
16 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
357 |
137 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
115 |
104 |
$3K |
| D0350 |
|
70 |
61 |
$1K |
| D0272 |
Bitewings - two radiographic images |
26 |
25 |
$584.50 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
14 |
12 |
$416.78 |
| D0603 |
|
677 |
638 |
$0.00 |
| D0602 |
|
293 |
281 |
$0.00 |
| D0431 |
|
544 |
511 |
$0.00 |
| D1999 |
|
169 |
156 |
$0.00 |