| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,947 |
2,929 |
$179K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,146 |
2,138 |
$69K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,486 |
2,467 |
$42K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
606 |
358 |
$42K |
| D0120 |
Periodic oral evaluation - established patient |
1,423 |
1,409 |
$39K |
| D0330 |
Panoramic radiographic image |
782 |
776 |
$31K |
| D0272 |
Bitewings - two radiographic images |
1,236 |
1,230 |
$27K |
| D1110 |
Prophylaxis - adult |
406 |
405 |
$22K |
| D1206 |
Topical application of fluoride varnish |
840 |
838 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
1,285 |
1,266 |
$15K |
| D1351 |
Sealant - per tooth |
460 |
142 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,229 |
831 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
327 |
326 |
$10K |
| D0274 |
Bitewings - four radiographic images |
368 |
366 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
165 |
103 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
139 |
81 |
$9K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
222 |
215 |
$8K |
| D2394 |
|
43 |
30 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
41 |
41 |
$2K |