| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
2,866 |
2,222 |
$128K |
| D1206 |
Topical application of fluoride varnish |
2,525 |
2,490 |
$63K |
| D1110 |
Prophylaxis - adult |
752 |
745 |
$47K |
| D0120 |
Periodic oral evaluation - established patient |
1,471 |
1,458 |
$44K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
230 |
88 |
$38K |
| D1120 |
Prophylaxis - child |
752 |
744 |
$32K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
225 |
102 |
$28K |
| D0274 |
Bitewings - four radiographic images |
1,146 |
1,133 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
2,441 |
2,048 |
$24K |
| D1351 |
Sealant - per tooth |
649 |
94 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,794 |
1,564 |
$11K |
| D4355 |
|
84 |
81 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
151 |
150 |
$8K |
| D0330 |
Panoramic radiographic image |
136 |
136 |
$6K |
| D0460 |
|
610 |
498 |
$6K |
| D1330 |
|
802 |
797 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
186 |
186 |
$4K |
| D9940 |
|
24 |
24 |
$4K |
| D0272 |
Bitewings - two radiographic images |
123 |
119 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
81 |
69 |
$1K |