| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,982 |
2,840 |
$49K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,217 |
3,052 |
$47K |
| D1120 |
Prophylaxis - child |
2,415 |
2,284 |
$44K |
| D0272 |
Bitewings - two radiographic images |
1,622 |
1,545 |
$16K |
| D1110 |
Prophylaxis - adult |
480 |
451 |
$14K |
| D0274 |
Bitewings - four radiographic images |
148 |
142 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
27 |
12 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
13 |
13 |
$325.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
13 |
12 |
$237.15 |