| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,830 |
2,779 |
$119K |
| D1206 |
Topical application of fluoride varnish |
4,619 |
4,536 |
$95K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,977 |
2,336 |
$86K |
| D0120 |
Periodic oral evaluation - established patient |
3,520 |
3,460 |
$84K |
| D0274 |
Bitewings - four radiographic images |
2,619 |
2,574 |
$70K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
757 |
481 |
$58K |
| D1120 |
Prophylaxis - child |
1,725 |
1,692 |
$57K |
| D0330 |
Panoramic radiographic image |
743 |
725 |
$34K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
980 |
963 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
1,486 |
1,384 |
$18K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
218 |
139 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,596 |
836 |
$15K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
144 |
102 |
$13K |
| D1351 |
Sealant - per tooth |
173 |
41 |
$5K |
| D0272 |
Bitewings - two radiographic images |
239 |
231 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
133 |
132 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
37 |
26 |
$2K |
| D2160 |
|
13 |
12 |
$1K |