| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,264 |
1,141 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,209 |
1,089 |
$15K |
| D1110 |
Prophylaxis - adult |
412 |
366 |
$12K |
| D1120 |
Prophylaxis - child |
395 |
365 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
138 |
74 |
$9K |
| D0330 |
Panoramic radiographic image |
224 |
201 |
$9K |
| D0274 |
Bitewings - four radiographic images |
326 |
292 |
$6K |
| D0272 |
Bitewings - two radiographic images |
313 |
287 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
254 |
184 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
136 |
122 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
13 |
12 |
$1K |
| D3120 |
|
23 |
15 |
$384.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
42 |
31 |
$370.00 |