| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,120 |
1,092 |
$51K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
450 |
230 |
$46K |
| D1206 |
Topical application of fluoride varnish |
2,129 |
2,068 |
$36K |
| D0120 |
Periodic oral evaluation - established patient |
1,567 |
1,517 |
$33K |
| D0330 |
Panoramic radiographic image |
677 |
661 |
$33K |
| D0274 |
Bitewings - four radiographic images |
899 |
862 |
$27K |
| D1120 |
Prophylaxis - child |
777 |
750 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
1,465 |
1,405 |
$22K |
| D1351 |
Sealant - per tooth |
752 |
187 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,121 |
870 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
496 |
481 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
363 |
345 |
$11K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
42 |
24 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
13 |
13 |
$356.72 |
| D0272 |
Bitewings - two radiographic images |
19 |
12 |
$347.51 |
| D0602 |
|
12 |
12 |
$109.80 |