| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,294 |
1,254 |
$28K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
333 |
151 |
$20K |
| D1120 |
Prophylaxis - child |
870 |
840 |
$19K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,288 |
1,247 |
$18K |
| D1110 |
Prophylaxis - adult |
455 |
441 |
$16K |
| D1351 |
Sealant - per tooth |
588 |
167 |
$13K |
| D0272 |
Bitewings - two radiographic images |
1,219 |
1,175 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,051 |
1,285 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
1,443 |
1,361 |
$11K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
501 |
437 |
$10K |
| D0330 |
Panoramic radiographic image |
89 |
82 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
133 |
129 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
20 |
12 |
$1K |
| D9999 |
Unspecified adjunctive procedure, by report |
12 |
12 |
$303.38 |