| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,462 |
2,333 |
$113K |
| D1120 |
Prophylaxis - child |
3,364 |
3,220 |
$101K |
| D0330 |
Panoramic radiographic image |
2,027 |
1,916 |
$100K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
766 |
576 |
$85K |
| D0120 |
Periodic oral evaluation - established patient |
4,037 |
3,859 |
$85K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,088 |
4,866 |
$77K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,847 |
1,750 |
$56K |
| D0274 |
Bitewings - four radiographic images |
1,454 |
1,413 |
$45K |
| D0272 |
Bitewings - two radiographic images |
1,947 |
1,864 |
$36K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,008 |
952 |
$27K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
301 |
206 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
1,033 |
991 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
482 |
457 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
123 |
74 |
$892.39 |
| D0210 |
Intraoral - complete series of radiographic images |
33 |
15 |
$681.53 |