| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,020 |
2,786 |
$66K |
| D1120 |
Prophylaxis - child |
2,124 |
1,983 |
$65K |
| D1110 |
Prophylaxis - adult |
1,649 |
1,511 |
$58K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,975 |
2,760 |
$51K |
| D0330 |
Panoramic radiographic image |
1,030 |
913 |
$38K |
| D0272 |
Bitewings - two radiographic images |
2,115 |
1,961 |
$31K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
290 |
110 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
580 |
508 |
$14K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
106 |
52 |
$7K |
| D1206 |
Topical application of fluoride varnish |
235 |
209 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
105 |
84 |
$985.59 |
| D0274 |
Bitewings - four radiographic images |
24 |
24 |
$618.80 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
17 |
13 |
$491.47 |