| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
5,100 |
4,963 |
$127K |
| D1120 |
Prophylaxis - child |
3,859 |
3,760 |
$123K |
| D1206 |
Topical application of fluoride varnish |
5,806 |
5,643 |
$86K |
| D1110 |
Prophylaxis - adult |
1,172 |
1,128 |
$45K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
335 |
190 |
$30K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
987 |
907 |
$29K |
| D0272 |
Bitewings - two radiographic images |
850 |
832 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
285 |
276 |
$3K |
| D1351 |
Sealant - per tooth |
116 |
38 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
21 |
14 |
$2K |
| D0330 |
Panoramic radiographic image |
27 |
25 |
$946.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12 |
12 |
$797.64 |
| D0274 |
Bitewings - four radiographic images |
14 |
13 |
$532.20 |
| D0230 |
Intraoral - periapical each additional radiographic image |
21 |
13 |
$325.00 |