| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,602 |
1,466 |
$54K |
| D0120 |
Periodic oral evaluation - established patient |
2,281 |
2,080 |
$40K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,362 |
2,126 |
$31K |
| D0274 |
Bitewings - four radiographic images |
1,486 |
1,351 |
$29K |
| D1120 |
Prophylaxis - child |
863 |
761 |
$21K |
| D0330 |
Panoramic radiographic image |
343 |
306 |
$14K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
218 |
118 |
$13K |
| D0272 |
Bitewings - two radiographic images |
712 |
624 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
94 |
78 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
37 |
28 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
90 |
76 |
$2K |
| D1206 |
Topical application of fluoride varnish |
26 |
24 |
$615.90 |