| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
8,656 |
8,418 |
$266K |
| D1120 |
Prophylaxis - child |
7,034 |
6,825 |
$260K |
| D1206 |
Topical application of fluoride varnish |
8,732 |
8,467 |
$161K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,414 |
919 |
$149K |
| D1110 |
Prophylaxis - adult |
2,480 |
2,419 |
$130K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,354 |
919 |
$127K |
| D0272 |
Bitewings - two radiographic images |
2,988 |
2,921 |
$79K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,951 |
1,746 |
$77K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
489 |
462 |
$28K |
| D0274 |
Bitewings - four radiographic images |
798 |
784 |
$25K |
| D0330 |
Panoramic radiographic image |
344 |
338 |
$14K |
| D1351 |
Sealant - per tooth |
270 |
94 |
$8K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
35 |
12 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
162 |
144 |
$1K |
| D0240 |
|
97 |
46 |
$565.44 |
| D0230 |
Intraoral - periapical each additional radiographic image |
20 |
16 |
$90.44 |