| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,759 |
2,248 |
$100K |
| D0120 |
Periodic oral evaluation - established patient |
3,695 |
3,008 |
$86K |
| D1110 |
Prophylaxis - adult |
1,757 |
1,415 |
$81K |
| D1206 |
Topical application of fluoride varnish |
3,695 |
2,984 |
$71K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
773 |
423 |
$55K |
| D0272 |
Bitewings - two radiographic images |
2,353 |
1,904 |
$54K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
517 |
325 |
$53K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,320 |
1,010 |
$39K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
697 |
582 |
$22K |
| D0140 |
Limited oral evaluation - problem focused |
380 |
315 |
$12K |
| D0330 |
Panoramic radiographic image |
45 |
38 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
101 |
91 |
$1K |