| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
809 |
788 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
875 |
840 |
$12K |
| D1999 |
|
815 |
712 |
$9K |
| D1120 |
Prophylaxis - child |
340 |
317 |
$8K |
| D1110 |
Prophylaxis - adult |
209 |
200 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
202 |
171 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
49 |
28 |
$3K |
| D0272 |
Bitewings - two radiographic images |
81 |
73 |
$1K |
| D0274 |
Bitewings - four radiographic images |
39 |
37 |
$817.20 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
27 |
27 |
$591.60 |
| D0330 |
Panoramic radiographic image |
13 |
13 |
$588.00 |
| D0220 |
Intraoral - periapical first radiographic image |
16 |
15 |
$154.00 |