| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
788 |
750 |
$40K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
715 |
683 |
$31K |
| D0330 |
Panoramic radiographic image |
691 |
657 |
$23K |
| D0120 |
Periodic oral evaluation - established patient |
706 |
682 |
$21K |
| D1206 |
Topical application of fluoride varnish |
852 |
820 |
$17K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
235 |
107 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
466 |
418 |
$15K |
| D0274 |
Bitewings - four radiographic images |
665 |
639 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
79 |
37 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
444 |
415 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
45 |
41 |
$1K |
| D1120 |
Prophylaxis - child |
37 |
34 |
$666.42 |
| D0272 |
Bitewings - two radiographic images |
45 |
40 |
$397.53 |
| D0230 |
Intraoral - periapical each additional radiographic image |
72 |
65 |
$169.17 |