| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,524 |
2,480 |
$125K |
| D0120 |
Periodic oral evaluation - established patient |
4,412 |
4,356 |
$123K |
| D1120 |
Prophylaxis - child |
3,026 |
2,981 |
$106K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,861 |
3,803 |
$79K |
| D0272 |
Bitewings - two radiographic images |
2,746 |
2,689 |
$58K |
| D0220 |
Intraoral - periapical first radiographic image |
2,489 |
2,301 |
$34K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,795 |
1,831 |
$33K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
829 |
744 |
$32K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
248 |
101 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
499 |
478 |
$27K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
126 |
62 |
$18K |
| D1351 |
Sealant - per tooth |
340 |
107 |
$10K |
| D0330 |
Panoramic radiographic image |
66 |
65 |
$4K |
| D1206 |
Topical application of fluoride varnish |
125 |
122 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
27 |
27 |
$2K |