| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,219 |
1,186 |
$37K |
| D0120 |
Periodic oral evaluation - established patient |
1,713 |
1,676 |
$36K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,845 |
1,804 |
$28K |
| D1110 |
Prophylaxis - adult |
460 |
456 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
832 |
818 |
$12K |
| D0274 |
Bitewings - four radiographic images |
306 |
306 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
908 |
642 |
$7K |
| D0330 |
Panoramic radiographic image |
66 |
66 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
26 |
17 |
$3K |
| D0272 |
Bitewings - two radiographic images |
102 |
95 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
40 |
40 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
24 |
21 |
$603.68 |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$362.00 |