| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,656 |
1,474 |
$75K |
| D0120 |
Periodic oral evaluation - established patient |
2,789 |
2,485 |
$67K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,451 |
2,188 |
$49K |
| D1120 |
Prophylaxis - child |
1,366 |
1,220 |
$47K |
| D0272 |
Bitewings - two radiographic images |
1,276 |
1,139 |
$31K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
271 |
201 |
$30K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
272 |
237 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
108 |
83 |
$10K |
| D0330 |
Panoramic radiographic image |
170 |
163 |
$10K |
| D1351 |
Sealant - per tooth |
198 |
24 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
73 |
65 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
115 |
102 |
$2K |
| D0274 |
Bitewings - four radiographic images |
24 |
24 |
$976.80 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
18 |
18 |
$580.00 |