| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,485 |
1,445 |
$53K |
| D0120 |
Periodic oral evaluation - established patient |
2,361 |
2,280 |
$43K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,658 |
2,559 |
$38K |
| D1120 |
Prophylaxis - child |
1,014 |
965 |
$26K |
| D0330 |
Panoramic radiographic image |
553 |
518 |
$26K |
| D0274 |
Bitewings - four radiographic images |
768 |
740 |
$18K |
| D0272 |
Bitewings - two radiographic images |
484 |
459 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
85 |
50 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
65 |
39 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
139 |
127 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
123 |
108 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
36 |
26 |
$701.00 |
| D0220 |
Intraoral - periapical first radiographic image |
29 |
27 |
$309.00 |