| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,744 |
2,086 |
$63K |
| D0120 |
Periodic oral evaluation - established patient |
1,561 |
1,260 |
$36K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,584 |
1,958 |
$33K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
272 |
80 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
591 |
343 |
$12K |
| D0330 |
Panoramic radiographic image |
302 |
264 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
92 |
91 |
$7K |
| D0272 |
Bitewings - two radiographic images |
210 |
200 |
$4K |
| D0274 |
Bitewings - four radiographic images |
251 |
200 |
$4K |
| D1110 |
Prophylaxis - adult |
69 |
65 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
88 |
68 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
25 |
14 |
$2K |
| D9248 |
|
17 |
12 |
$913.76 |
| D1206 |
Topical application of fluoride varnish |
37 |
31 |
$715.77 |
| D0220 |
Intraoral - periapical first radiographic image |
21 |
17 |
$120.22 |