| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,200 |
3,922 |
$107K |
| D0120 |
Periodic oral evaluation - established patient |
5,771 |
5,385 |
$98K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,746 |
5,348 |
$76K |
| D1999 |
|
3,926 |
3,567 |
$69K |
| D1110 |
Prophylaxis - adult |
1,644 |
1,537 |
$55K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
836 |
461 |
$49K |
| D0272 |
Bitewings - two radiographic images |
2,203 |
2,046 |
$35K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,434 |
1,321 |
$28K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
362 |
202 |
$27K |
| D0330 |
Panoramic radiographic image |
450 |
424 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
320 |
299 |
$7K |
| D1206 |
Topical application of fluoride varnish |
272 |
251 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
458 |
409 |
$4K |
| D0274 |
Bitewings - four radiographic images |
114 |
108 |
$3K |
| D2140 |
|
44 |
24 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
13 |
12 |
$348.00 |