| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,665 |
1,558 |
$78K |
| D0120 |
Periodic oral evaluation - established patient |
2,403 |
2,276 |
$51K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
687 |
416 |
$46K |
| D1120 |
Prophylaxis - child |
1,041 |
973 |
$32K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,563 |
1,455 |
$30K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
780 |
681 |
$19K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
406 |
264 |
$19K |
| D0274 |
Bitewings - four radiographic images |
447 |
413 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
349 |
314 |
$14K |
| D1206 |
Topical application of fluoride varnish |
270 |
257 |
$7K |
| D0272 |
Bitewings - two radiographic images |
275 |
266 |
$6K |
| D0330 |
Panoramic radiographic image |
84 |
76 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
167 |
152 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
119 |
115 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
18 |
14 |
$158.00 |