| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,081 |
2,734 |
$49K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
671 |
330 |
$44K |
| D1110 |
Prophylaxis - adult |
1,401 |
1,238 |
$43K |
| D1120 |
Prophylaxis - child |
1,646 |
1,439 |
$39K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,466 |
2,182 |
$31K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
434 |
225 |
$24K |
| D0330 |
Panoramic radiographic image |
406 |
344 |
$16K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
734 |
542 |
$12K |
| D0274 |
Bitewings - four radiographic images |
591 |
521 |
$11K |
| D0272 |
Bitewings - two radiographic images |
743 |
645 |
$11K |
| D1206 |
Topical application of fluoride varnish |
257 |
220 |
$5K |
| D1351 |
Sealant - per tooth |
136 |
33 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
276 |
242 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
83 |
73 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
14 |
13 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
106 |
93 |
$987.00 |
| D0140 |
Limited oral evaluation - problem focused |
38 |
29 |
$791.70 |