| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
904 |
701 |
$18K |
| D0330 |
Panoramic radiographic image |
481 |
377 |
$15K |
| D1120 |
Prophylaxis - child |
549 |
467 |
$14K |
| D1110 |
Prophylaxis - adult |
310 |
230 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
700 |
563 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
72 |
39 |
$8K |
| D0272 |
Bitewings - two radiographic images |
475 |
355 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
252 |
183 |
$6K |
| D0274 |
Bitewings - four radiographic images |
47 |
46 |
$1K |
| D1206 |
Topical application of fluoride varnish |
54 |
36 |
$728.70 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
16 |
16 |
$723.03 |
| D0220 |
Intraoral - periapical first radiographic image |
61 |
40 |
$202.97 |