| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,972 |
1,689 |
$44K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,844 |
2,371 |
$33K |
| D0120 |
Periodic oral evaluation - established patient |
2,316 |
1,962 |
$33K |
| D1110 |
Prophylaxis - adult |
1,263 |
1,052 |
$31K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
515 |
214 |
$28K |
| D0330 |
Panoramic radiographic image |
962 |
746 |
$28K |
| D1999 |
|
1,217 |
996 |
$21K |
| D0272 |
Bitewings - two radiographic images |
1,408 |
1,197 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
2,061 |
1,634 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,272 |
1,585 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
963 |
753 |
$15K |
| D0274 |
Bitewings - four radiographic images |
992 |
800 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
246 |
136 |
$11K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
535 |
362 |
$7K |
| D1351 |
Sealant - per tooth |
74 |
12 |
$962.00 |
| D0140 |
Limited oral evaluation - problem focused |
48 |
41 |
$841.00 |
| D1206 |
Topical application of fluoride varnish |
37 |
31 |
$465.00 |