| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,444 |
3,313 |
$55K |
| D0120 |
Periodic oral evaluation - established patient |
4,025 |
3,856 |
$42K |
| D1206 |
Topical application of fluoride varnish |
4,397 |
4,224 |
$34K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,400 |
828 |
$33K |
| D0220 |
Intraoral - periapical first radiographic image |
4,765 |
4,505 |
$24K |
| D1110 |
Prophylaxis - adult |
1,294 |
1,232 |
$20K |
| D0274 |
Bitewings - four radiographic images |
1,639 |
1,569 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,198 |
3,878 |
$18K |
| D0272 |
Bitewings - two radiographic images |
1,995 |
1,914 |
$18K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
478 |
316 |
$16K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
469 |
408 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
136 |
131 |
$2K |
| D0240 |
|
164 |
138 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
334 |
323 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
230 |
223 |
$377.52 |
| D1999 |
|
99 |
81 |
$0.00 |
| D0330 |
Panoramic radiographic image |
19 |
19 |
$0.00 |
| D1354 |
|
48 |
15 |
$0.00 |
| D1351 |
Sealant - per tooth |
38 |
13 |
$0.00 |