| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
6,192 |
6,078 |
$266K |
| D0120 |
Periodic oral evaluation - established patient |
8,686 |
8,548 |
$254K |
| D1206 |
Topical application of fluoride varnish |
9,663 |
9,494 |
$237K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,971 |
1,226 |
$236K |
| D1110 |
Prophylaxis - adult |
3,639 |
3,582 |
$215K |
| D0274 |
Bitewings - four radiographic images |
4,751 |
4,676 |
$105K |
| D0330 |
Panoramic radiographic image |
1,853 |
1,816 |
$79K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,198 |
1,173 |
$62K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
541 |
407 |
$50K |
| D0272 |
Bitewings - two radiographic images |
3,166 |
3,115 |
$48K |
| D1330 |
|
5,697 |
5,594 |
$35K |
| D0140 |
Limited oral evaluation - problem focused |
731 |
699 |
$32K |
| D0220 |
Intraoral - periapical first radiographic image |
1,638 |
1,482 |
$16K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
450 |
397 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
333 |
320 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
18 |
12 |
$3K |
| D1351 |
Sealant - per tooth |
50 |
16 |
$2K |