| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,248 |
2,209 |
$63K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
620 |
251 |
$59K |
| D1120 |
Prophylaxis - child |
1,570 |
1,552 |
$56K |
| D1110 |
Prophylaxis - adult |
960 |
950 |
$52K |
| D1351 |
Sealant - per tooth |
1,526 |
324 |
$41K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,677 |
2,648 |
$38K |
| D0274 |
Bitewings - four radiographic images |
1,115 |
1,091 |
$33K |
| D0272 |
Bitewings - two radiographic images |
1,196 |
1,176 |
$26K |
| D0145 |
Oral evaluation for a patient under three years of age |
86 |
86 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
343 |
326 |
$11K |
| D0330 |
Panoramic radiographic image |
331 |
315 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
88 |
53 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
103 |
92 |
$3K |
| D0240 |
|
134 |
68 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$847.68 |
| D0220 |
Intraoral - periapical first radiographic image |
27 |
26 |
$252.82 |
| D1999 |
|
511 |
478 |
$70.00 |
| D0602 |
|
377 |
376 |
$0.00 |
| D0603 |
|
2,492 |
2,452 |
$0.00 |
| D0601 |
|
17 |
17 |
$0.00 |