| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,944 |
2,912 |
$52K |
| D1110 |
Prophylaxis - adult |
1,220 |
1,214 |
$44K |
| D1120 |
Prophylaxis - child |
1,490 |
1,472 |
$39K |
| D1206 |
Topical application of fluoride varnish |
2,146 |
2,113 |
$33K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
364 |
192 |
$29K |
| D0274 |
Bitewings - four radiographic images |
603 |
597 |
$15K |
| D0272 |
Bitewings - two radiographic images |
206 |
197 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
197 |
194 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
65 |
51 |
$1K |
| D0330 |
Panoramic radiographic image |
24 |
24 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
15 |
12 |
$928.84 |
| D0140 |
Limited oral evaluation - problem focused |
25 |
25 |
$660.89 |