| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,154 |
3,084 |
$86K |
| D1120 |
Prophylaxis - child |
1,921 |
1,876 |
$66K |
| D1110 |
Prophylaxis - adult |
903 |
884 |
$47K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,246 |
3,175 |
$45K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
509 |
267 |
$44K |
| D0272 |
Bitewings - two radiographic images |
1,750 |
1,712 |
$37K |
| D0274 |
Bitewings - four radiographic images |
833 |
813 |
$25K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
150 |
93 |
$11K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
407 |
381 |
$10K |
| D0330 |
Panoramic radiographic image |
110 |
108 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$777.04 |
| D0602 |
|
3,206 |
3,155 |
$0.00 |
| D0601 |
|
38 |
38 |
$0.00 |