| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,967 |
1,730 |
$59K |
| D0120 |
Periodic oral evaluation - established patient |
1,577 |
1,398 |
$34K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,117 |
928 |
$34K |
| D1206 |
Topical application of fluoride varnish |
2,034 |
1,905 |
$32K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
304 |
185 |
$30K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
708 |
617 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
1,645 |
1,454 |
$20K |
| D0272 |
Bitewings - two radiographic images |
925 |
839 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,403 |
1,122 |
$14K |
| D0330 |
Panoramic radiographic image |
256 |
216 |
$9K |
| D1110 |
Prophylaxis - adult |
169 |
166 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
81 |
51 |
$8K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
46 |
27 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
177 |
99 |
$2K |
| D0274 |
Bitewings - four radiographic images |
59 |
56 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
13 |
13 |
$513.72 |