| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,180 |
2,019 |
$42K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
630 |
345 |
$41K |
| D1120 |
Prophylaxis - child |
1,371 |
1,281 |
$37K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,022 |
1,924 |
$33K |
| D0274 |
Bitewings - four radiographic images |
911 |
849 |
$25K |
| D1351 |
Sealant - per tooth |
1,189 |
169 |
$20K |
| D1110 |
Prophylaxis - adult |
579 |
545 |
$20K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
828 |
714 |
$16K |
| D1206 |
Topical application of fluoride varnish |
606 |
504 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
67 |
44 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
69 |
68 |
$2K |
| D0272 |
Bitewings - two radiographic images |
78 |
77 |
$2K |
| D0330 |
Panoramic radiographic image |
31 |
30 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
14 |
13 |
$156.00 |
| D1999 |
|
48 |
43 |
$0.00 |