| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,210 |
1,173 |
$31K |
| D1110 |
Prophylaxis - adult |
655 |
620 |
$28K |
| D1120 |
Prophylaxis - child |
603 |
588 |
$19K |
| D1208 |
Topical application of fluoride, excluding varnish |
761 |
749 |
$15K |
| D0272 |
Bitewings - two radiographic images |
378 |
377 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
48 |
25 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
79 |
70 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
24 |
24 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$180.00 |