| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,279 |
1,243 |
$35K |
| D0274 |
Bitewings - four radiographic images |
1,052 |
1,020 |
$31K |
| D1110 |
Prophylaxis - adult |
583 |
567 |
$30K |
| D1120 |
Prophylaxis - child |
832 |
809 |
$29K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,525 |
1,487 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
165 |
153 |
$5K |
| D0272 |
Bitewings - two radiographic images |
141 |
133 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
17 |
12 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
28 |
27 |
$702.78 |
| D0603 |
|
1,115 |
1,087 |
$0.00 |
| D0602 |
|
550 |
544 |
$0.00 |