| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,944 |
1,745 |
$66K |
| D0120 |
Periodic oral evaluation - established patient |
2,111 |
1,973 |
$51K |
| D0274 |
Bitewings - four radiographic images |
1,268 |
1,082 |
$32K |
| D0330 |
Panoramic radiographic image |
886 |
735 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
637 |
518 |
$23K |
| D0140 |
Limited oral evaluation - problem focused |
740 |
541 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,272 |
1,217 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,434 |
1,181 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,496 |
380 |
$16K |
| D1120 |
Prophylaxis - child |
572 |
558 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
206 |
93 |
$13K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
71 |
28 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
56 |
40 |
$2K |
| D0272 |
Bitewings - two radiographic images |
96 |
91 |
$2K |
| D1206 |
Topical application of fluoride varnish |
15 |
15 |
$228.75 |