| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,414 |
1,371 |
$16K |
| D0120 |
Periodic oral evaluation - established patient |
1,373 |
1,321 |
$10K |
| D1206 |
Topical application of fluoride varnish |
1,635 |
1,578 |
$9K |
| D0272 |
Bitewings - two radiographic images |
802 |
778 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
908 |
870 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
800 |
752 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
152 |
77 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
133 |
130 |
$2K |
| D0274 |
Bitewings - four radiographic images |
183 |
172 |
$2K |
| D1110 |
Prophylaxis - adult |
142 |
137 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
207 |
175 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
48 |
25 |
$679.48 |
| D0330 |
Panoramic radiographic image |
26 |
26 |
$261.23 |
| D1999 |
|
287 |
280 |
$153.00 |
| D1354 |
|
43 |
13 |
$77.40 |
| D1330 |
|
1,068 |
1,013 |
$0.00 |