| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,730 |
1,698 |
$106K |
| D0120 |
Periodic oral evaluation - established patient |
2,016 |
1,975 |
$40K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
718 |
714 |
$29K |
| D0330 |
Panoramic radiographic image |
410 |
408 |
$28K |
| D1120 |
Prophylaxis - child |
938 |
930 |
$15K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
241 |
147 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,744 |
2,701 |
$11K |
| D1351 |
Sealant - per tooth |
1,793 |
477 |
$7K |
| D0274 |
Bitewings - four radiographic images |
1,430 |
1,404 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,852 |
1,645 |
$3K |
| D0272 |
Bitewings - two radiographic images |
727 |
721 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
1,751 |
1,728 |
$2K |
| D1330 |
|
2,462 |
2,419 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
15 |
12 |
$816.46 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
14 |
13 |
$730.77 |
| D1999 |
|
32 |
32 |
$686.00 |