| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,189 |
1,176 |
$56K |
| D0330 |
Panoramic radiographic image |
959 |
946 |
$53K |
| D0120 |
Periodic oral evaluation - established patient |
1,636 |
1,624 |
$45K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
294 |
142 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,165 |
1,156 |
$22K |
| D1120 |
Prophylaxis - child |
575 |
571 |
$19K |
| D0272 |
Bitewings - two radiographic images |
927 |
916 |
$19K |
| D9243 |
|
132 |
57 |
$10K |
| D9248 |
|
55 |
50 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
369 |
361 |
$5K |
| D9239 |
|
50 |
44 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
21 |
12 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
27 |
27 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
38 |
37 |
$470.08 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
13 |
13 |
$463.89 |