| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1354 |
|
8,056 |
1,633 |
$240K |
| D1120 |
Prophylaxis - child |
2,280 |
2,144 |
$59K |
| D0120 |
Periodic oral evaluation - established patient |
3,182 |
3,002 |
$57K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,709 |
3,471 |
$51K |
| D1110 |
Prophylaxis - adult |
1,208 |
1,142 |
$42K |
| D0330 |
Panoramic radiographic image |
539 |
509 |
$24K |
| D0272 |
Bitewings - two radiographic images |
1,016 |
962 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
458 |
417 |
$11K |
| D0274 |
Bitewings - four radiographic images |
391 |
364 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
108 |
65 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
116 |
101 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
26 |
14 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
30 |
27 |
$700.35 |
| D0220 |
Intraoral - periapical first radiographic image |
14 |
12 |
$111.50 |