| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,501 |
2,316 |
$89K |
| D0120 |
Periodic oral evaluation - established patient |
2,382 |
2,160 |
$69K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,201 |
2,939 |
$56K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,022 |
905 |
$49K |
| D1110 |
Prophylaxis - adult |
715 |
584 |
$30K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
311 |
159 |
$28K |
| D0140 |
Limited oral evaluation - problem focused |
523 |
428 |
$21K |
| D0272 |
Bitewings - two radiographic images |
768 |
699 |
$19K |
| D1351 |
Sealant - per tooth |
474 |
179 |
$16K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
412 |
301 |
$14K |
| D0274 |
Bitewings - four radiographic images |
213 |
198 |
$7K |
| D0330 |
Panoramic radiographic image |
103 |
99 |
$4K |
| D3120 |
|
116 |
76 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
18 |
13 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
278 |
236 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
56 |
28 |
$303.04 |