| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,112 |
1,090 |
$68K |
| D0120 |
Periodic oral evaluation - established patient |
1,851 |
1,816 |
$54K |
| D0140 |
Limited oral evaluation - problem focused |
972 |
934 |
$43K |
| D1206 |
Topical application of fluoride varnish |
1,538 |
1,514 |
$39K |
| D1120 |
Prophylaxis - child |
797 |
781 |
$34K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
199 |
123 |
$27K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
251 |
138 |
$26K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
826 |
769 |
$18K |
| D0330 |
Panoramic radiographic image |
267 |
262 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
173 |
169 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
631 |
590 |
$7K |
| D0272 |
Bitewings - two radiographic images |
146 |
145 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
42 |
40 |
$893.44 |
| D1330 |
|
78 |
78 |
$520.80 |
| D0274 |
Bitewings - four radiographic images |
16 |
16 |
$399.05 |
| D0230 |
Intraoral - periapical each additional radiographic image |
41 |
39 |
$316.99 |