| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
912 |
841 |
$35K |
| D0120 |
Periodic oral evaluation - established patient |
1,575 |
1,470 |
$32K |
| D1120 |
Prophylaxis - child |
702 |
662 |
$21K |
| D1206 |
Topical application of fluoride varnish |
1,040 |
962 |
$18K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
215 |
83 |
$12K |
| D0274 |
Bitewings - four radiographic images |
452 |
406 |
$12K |
| D0330 |
Panoramic radiographic image |
192 |
176 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
233 |
208 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
355 |
341 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
47 |
25 |
$3K |
| D0272 |
Bitewings - two radiographic images |
128 |
116 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
226 |
165 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
80 |
46 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
31 |
24 |
$466.65 |
| D9920 |
|
78 |
45 |
$0.00 |