| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,921 |
2,871 |
$148K |
| D0120 |
Periodic oral evaluation - established patient |
5,046 |
4,963 |
$135K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,522 |
5,180 |
$113K |
| D0274 |
Bitewings - four radiographic images |
3,312 |
3,233 |
$107K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
838 |
433 |
$73K |
| D1351 |
Sealant - per tooth |
2,894 |
625 |
$71K |
| D0220 |
Intraoral - periapical first radiographic image |
5,456 |
5,346 |
$66K |
| D1120 |
Prophylaxis - child |
1,769 |
1,758 |
$62K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,557 |
4,511 |
$61K |
| D0272 |
Bitewings - two radiographic images |
1,612 |
1,603 |
$37K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
151 |
97 |
$10K |
| D0145 |
Oral evaluation for a patient under three years of age |
50 |
50 |
$7K |
| D4341 |
|
44 |
12 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
111 |
107 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
60 |
57 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
81 |
81 |
$1K |
| D0330 |
Panoramic radiographic image |
39 |
39 |
$279.27 |
| D0603 |
|
5,172 |
5,099 |
$0.00 |
| D0602 |
|
576 |
569 |
$0.00 |
| D9222 |
|
12 |
12 |
$0.00 |