| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,418 |
1,386 |
$57K |
| D0120 |
Periodic oral evaluation - established patient |
2,410 |
2,352 |
$56K |
| D1206 |
Topical application of fluoride varnish |
2,741 |
2,684 |
$56K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
779 |
448 |
$55K |
| D1120 |
Prophylaxis - child |
1,570 |
1,534 |
$51K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
858 |
480 |
$50K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
949 |
886 |
$27K |
| D0274 |
Bitewings - four radiographic images |
653 |
642 |
$17K |
| D0330 |
Panoramic radiographic image |
311 |
302 |
$14K |
| D0272 |
Bitewings - two radiographic images |
688 |
667 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
219 |
218 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
16 |
16 |
$287.80 |
| D0220 |
Intraoral - periapical first radiographic image |
13 |
13 |
$166.53 |