| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,868 |
1,818 |
$47K |
| D1110 |
Prophylaxis - adult |
1,068 |
1,038 |
$39K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
303 |
150 |
$32K |
| D1120 |
Prophylaxis - child |
912 |
889 |
$24K |
| D0274 |
Bitewings - four radiographic images |
729 |
698 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,097 |
1,063 |
$18K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
134 |
74 |
$10K |
| D0330 |
Panoramic radiographic image |
158 |
149 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
165 |
154 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
144 |
133 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
335 |
308 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
239 |
150 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
46 |
42 |
$2K |
| D1206 |
Topical application of fluoride varnish |
103 |
100 |
$2K |
| D0272 |
Bitewings - two radiographic images |
39 |
39 |
$703.74 |