| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,636 |
2,274 |
$39K |
| D1110 |
Prophylaxis - adult |
1,233 |
1,056 |
$34K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,086 |
1,510 |
$33K |
| D1120 |
Prophylaxis - child |
1,399 |
1,272 |
$32K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,314 |
2,085 |
$30K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
299 |
180 |
$19K |
| D0274 |
Bitewings - four radiographic images |
631 |
548 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
136 |
76 |
$6K |
| D0272 |
Bitewings - two radiographic images |
369 |
351 |
$6K |
| D0330 |
Panoramic radiographic image |
77 |
73 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
35 |
29 |
$842.45 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
49 |
43 |
$770.00 |
| D0220 |
Intraoral - periapical first radiographic image |
75 |
63 |
$682.55 |