| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,532 |
4,341 |
$225K |
| D0120 |
Periodic oral evaluation - established patient |
4,696 |
4,509 |
$133K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,025 |
690 |
$95K |
| D1206 |
Topical application of fluoride varnish |
3,190 |
3,061 |
$83K |
| D0272 |
Bitewings - two radiographic images |
1,642 |
1,552 |
$47K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,344 |
1,298 |
$37K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,059 |
1,781 |
$37K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
383 |
253 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
355 |
332 |
$19K |
| D0330 |
Panoramic radiographic image |
183 |
172 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
156 |
125 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
648 |
600 |
$12K |
| D1110 |
Prophylaxis - adult |
53 |
51 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
59 |
53 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
85 |
70 |
$1K |