| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
516 |
512 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
483 |
479 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
430 |
426 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
145 |
122 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
333 |
326 |
$7K |
| D1110 |
Prophylaxis - adult |
164 |
161 |
$6K |
| D0274 |
Bitewings - four radiographic images |
295 |
292 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
533 |
524 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
462 |
453 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
48 |
41 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
70 |
69 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
41 |
40 |
$490.70 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
15 |
13 |
$364.00 |
| D0272 |
Bitewings - two radiographic images |
26 |
24 |
$216.20 |