| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,242 |
2,241 |
$120K |
| D0120 |
Periodic oral evaluation - established patient |
2,127 |
2,126 |
$58K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
375 |
248 |
$36K |
| D1120 |
Prophylaxis - child |
465 |
465 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
636 |
636 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
237 |
237 |
$18K |
| D0274 |
Bitewings - four radiographic images |
405 |
405 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
554 |
554 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
47 |
41 |
$6K |
| D2394 |
|
43 |
39 |
$6K |
| D2160 |
|
17 |
12 |
$2K |
| D9110 |
|
56 |
53 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
39 |
37 |
$522.50 |
| D9990 |
|
106 |
93 |
$385.00 |