| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,055 |
3,005 |
$131K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,962 |
4,889 |
$102K |
| D0120 |
Periodic oral evaluation - established patient |
4,242 |
4,184 |
$101K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,274 |
2,962 |
$94K |
| D1120 |
Prophylaxis - child |
1,639 |
1,619 |
$53K |
| D0272 |
Bitewings - two radiographic images |
2,828 |
2,792 |
$48K |
| D0330 |
Panoramic radiographic image |
771 |
757 |
$37K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
169 |
136 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
348 |
341 |
$9K |
| D1351 |
Sealant - per tooth |
283 |
109 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
549 |
519 |
$6K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
71 |
55 |
$5K |
| D2140 |
|
31 |
26 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
32 |
13 |
$288.26 |