| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,171 |
2,142 |
$42K |
| D1120 |
Prophylaxis - child |
1,204 |
1,192 |
$33K |
| D1110 |
Prophylaxis - adult |
858 |
840 |
$30K |
| D1206 |
Topical application of fluoride varnish |
1,104 |
1,089 |
$22K |
| D0330 |
Panoramic radiographic image |
391 |
380 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
1,462 |
1,401 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
924 |
906 |
$13K |
| D1999 |
|
1,030 |
976 |
$13K |
| D0274 |
Bitewings - four radiographic images |
505 |
491 |
$12K |
| D0272 |
Bitewings - two radiographic images |
627 |
619 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
308 |
305 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
22 |
14 |
$2K |
| D1351 |
Sealant - per tooth |
57 |
12 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
47 |
38 |
$920.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
97 |
93 |
$915.50 |