| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,626 |
1,622 |
$45K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
622 |
498 |
$44K |
| D1120 |
Prophylaxis - child |
953 |
948 |
$38K |
| D1206 |
Topical application of fluoride varnish |
1,941 |
1,928 |
$36K |
| D1110 |
Prophylaxis - adult |
537 |
536 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
633 |
632 |
$24K |
| D1351 |
Sealant - per tooth |
592 |
185 |
$20K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
264 |
222 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
1,119 |
1,106 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
252 |
252 |
$14K |
| D0274 |
Bitewings - four radiographic images |
474 |
474 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
994 |
927 |
$9K |
| D0272 |
Bitewings - two radiographic images |
421 |
419 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
169 |
166 |
$6K |
| D1354 |
|
387 |
373 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
134 |
128 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
86 |
86 |
$2K |
| D4910 |
|
19 |
19 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
14 |
14 |
$1K |
| D0270 |
|
27 |
27 |
$297.00 |