| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,060 |
1,027 |
$29K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
282 |
104 |
$28K |
| D1120 |
Prophylaxis - child |
718 |
691 |
$25K |
| D1110 |
Prophylaxis - adult |
337 |
320 |
$17K |
| D0274 |
Bitewings - four radiographic images |
396 |
380 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
997 |
955 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
844 |
813 |
$12K |
| D0272 |
Bitewings - two radiographic images |
445 |
429 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
869 |
834 |
$9K |
| D1206 |
Topical application of fluoride varnish |
261 |
250 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
191 |
163 |
$5K |
| D1351 |
Sealant - per tooth |
170 |
41 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
23 |
12 |
$2K |
| D2140 |
|
25 |
12 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
14 |
14 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
30 |
28 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
14 |
14 |
$487.42 |
| D0603 |
|
1,157 |
1,116 |
$1.47 |