| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,834 |
4,752 |
$142K |
| D1120 |
Prophylaxis - child |
3,143 |
3,086 |
$136K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,305 |
5,211 |
$121K |
| D1110 |
Prophylaxis - adult |
1,960 |
1,928 |
$117K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
289 |
146 |
$38K |
| D0330 |
Panoramic radiographic image |
506 |
500 |
$21K |
| D0274 |
Bitewings - four radiographic images |
872 |
853 |
$19K |
| D0272 |
Bitewings - two radiographic images |
942 |
925 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
1,079 |
1,056 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
128 |
127 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
915 |
896 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
20 |
12 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
144 |
130 |
$3K |