| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,745 |
3,633 |
$123K |
| D0120 |
Periodic oral evaluation - established patient |
5,120 |
4,952 |
$121K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,753 |
5,567 |
$114K |
| D1110 |
Prophylaxis - adult |
2,630 |
2,547 |
$111K |
| D0210 |
Intraoral - complete series of radiographic images |
1,370 |
1,340 |
$79K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,136 |
1,815 |
$61K |
| D0272 |
Bitewings - two radiographic images |
2,367 |
2,282 |
$41K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,089 |
1,060 |
$31K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
431 |
227 |
$27K |
| D2140 |
|
230 |
152 |
$14K |
| D9110 |
|
72 |
68 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
168 |
161 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
14 |
12 |
$1K |
| D0330 |
Panoramic radiographic image |
15 |
15 |
$596.76 |