| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,642 |
1,413 |
$48K |
| D0120 |
Periodic oral evaluation - established patient |
1,865 |
1,619 |
$28K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,170 |
1,899 |
$27K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
370 |
180 |
$21K |
| D0274 |
Bitewings - four radiographic images |
890 |
761 |
$17K |
| D1999 |
|
725 |
570 |
$12K |
| D0330 |
Panoramic radiographic image |
236 |
220 |
$10K |
| D1120 |
Prophylaxis - child |
342 |
311 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
411 |
303 |
$7K |
| D0272 |
Bitewings - two radiographic images |
121 |
103 |
$2K |
| D1206 |
Topical application of fluoride varnish |
64 |
57 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
27 |
14 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
43 |
39 |
$941.60 |