| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
888 |
882 |
$29K |
| D1110 |
Prophylaxis - adult |
520 |
513 |
$28K |
| D1120 |
Prophylaxis - child |
544 |
542 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
873 |
864 |
$20K |
| D0330 |
Panoramic radiographic image |
317 |
314 |
$17K |
| D0272 |
Bitewings - two radiographic images |
678 |
672 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
246 |
242 |
$14K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
112 |
88 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
111 |
84 |
$10K |
| D1351 |
Sealant - per tooth |
276 |
94 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
600 |
558 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
105 |
100 |
$4K |
| D1206 |
Topical application of fluoride varnish |
151 |
151 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
227 |
221 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
243 |
222 |
$2K |