| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
985 |
952 |
$50K |
| D0274 |
Bitewings - four radiographic images |
1,067 |
1,026 |
$33K |
| D0120 |
Periodic oral evaluation - established patient |
1,243 |
1,198 |
$33K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,440 |
1,385 |
$20K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
107 |
47 |
$9K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
171 |
157 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
52 |
26 |
$4K |
| D1120 |
Prophylaxis - child |
67 |
66 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
221 |
212 |
$2K |
| D0272 |
Bitewings - two radiographic images |
78 |
76 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
121 |
114 |
$1K |
| D0330 |
Panoramic radiographic image |
27 |
24 |
$533.83 |
| D0602 |
|
1,555 |
1,492 |
$0.00 |