| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,502 |
1,490 |
$41K |
| D1110 |
Prophylaxis - adult |
762 |
760 |
$36K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,291 |
1,284 |
$26K |
| D1120 |
Prophylaxis - child |
732 |
726 |
$24K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
275 |
171 |
$23K |
| D0210 |
Intraoral - complete series of radiographic images |
374 |
374 |
$22K |
| D0330 |
Panoramic radiographic image |
303 |
303 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
249 |
238 |
$10K |
| D0272 |
Bitewings - two radiographic images |
344 |
343 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
70 |
44 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
40 |
28 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
22 |
12 |
$734.60 |
| D0220 |
Intraoral - periapical first radiographic image |
18 |
18 |
$249.73 |