| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,680 |
1,628 |
$68K |
| D0120 |
Periodic oral evaluation - established patient |
2,494 |
2,423 |
$57K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
798 |
317 |
$57K |
| D1120 |
Prophylaxis - child |
1,417 |
1,382 |
$46K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
617 |
272 |
$38K |
| D0210 |
Intraoral - complete series of radiographic images |
601 |
588 |
$32K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,478 |
1,441 |
$30K |
| D1206 |
Topical application of fluoride varnish |
1,393 |
1,360 |
$28K |
| D0274 |
Bitewings - four radiographic images |
653 |
640 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
609 |
595 |
$16K |
| D0272 |
Bitewings - two radiographic images |
660 |
648 |
$12K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
116 |
106 |
$3K |
| D1351 |
Sealant - per tooth |
95 |
25 |
$3K |
| D0330 |
Panoramic radiographic image |
32 |
31 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
27 |
27 |
$516.08 |