| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,758 |
1,725 |
$82K |
| D0120 |
Periodic oral evaluation - established patient |
2,227 |
2,174 |
$53K |
| D0274 |
Bitewings - four radiographic images |
845 |
828 |
$27K |
| D1206 |
Topical application of fluoride varnish |
619 |
597 |
$12K |
| D1120 |
Prophylaxis - child |
263 |
256 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
63 |
39 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
20 |
13 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
20 |
13 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
16 |
16 |
$556.38 |
| D0220 |
Intraoral - periapical first radiographic image |
13 |
13 |
$240.52 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
14 |
12 |
$236.40 |
| D0272 |
Bitewings - two radiographic images |
14 |
13 |
$23.34 |