| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,282 |
1,268 |
$55K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,849 |
1,828 |
$40K |
| D0120 |
Periodic oral evaluation - established patient |
1,369 |
1,362 |
$33K |
| D0274 |
Bitewings - four radiographic images |
1,141 |
1,125 |
$30K |
| D0330 |
Panoramic radiographic image |
707 |
698 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
574 |
558 |
$16K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
481 |
445 |
$14K |
| D1120 |
Prophylaxis - child |
325 |
320 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
829 |
820 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
123 |
91 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
639 |
607 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
28 |
24 |
$2K |