| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,980 |
1,959 |
$55K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
594 |
315 |
$54K |
| D1120 |
Prophylaxis - child |
1,427 |
1,414 |
$51K |
| D0145 |
Oral evaluation for a patient under three years of age |
308 |
301 |
$42K |
| D1110 |
Prophylaxis - adult |
614 |
607 |
$32K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,210 |
2,189 |
$32K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,470 |
1,699 |
$27K |
| D0274 |
Bitewings - four radiographic images |
720 |
710 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
1,820 |
1,789 |
$22K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
617 |
553 |
$15K |
| D0272 |
Bitewings - two radiographic images |
437 |
432 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
126 |
121 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
48 |
28 |
$4K |
| D1351 |
Sealant - per tooth |
41 |
12 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
14 |
13 |
$457.78 |
| D0602 |
|
1,859 |
1,842 |
$0.00 |
| D0603 |
|
238 |
235 |
$0.00 |
| D0601 |
|
327 |
322 |
$0.00 |
| D1999 |
|
184 |
169 |
$0.00 |