| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,229 |
1,197 |
$49K |
| D0120 |
Periodic oral evaluation - established patient |
1,944 |
1,902 |
$44K |
| D1120 |
Prophylaxis - child |
1,163 |
1,138 |
$38K |
| D1206 |
Topical application of fluoride varnish |
1,116 |
1,100 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
797 |
780 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
437 |
428 |
$12K |
| D0210 |
Intraoral - complete series of radiographic images |
184 |
181 |
$10K |
| D2740 |
Crown - porcelain/ceramic |
18 |
14 |
$10K |
| D0272 |
Bitewings - two radiographic images |
522 |
512 |
$9K |
| D0274 |
Bitewings - four radiographic images |
365 |
356 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
50 |
25 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
13 |
12 |
$380.25 |