| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
4,337 |
4,332 |
$109K |
| D1120 |
Prophylaxis - child |
2,744 |
2,741 |
$103K |
| D1110 |
Prophylaxis - adult |
1,695 |
1,694 |
$77K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,470 |
2,466 |
$54K |
| D0272 |
Bitewings - two radiographic images |
2,505 |
2,500 |
$52K |
| D1351 |
Sealant - per tooth |
1,628 |
325 |
$51K |
| D1206 |
Topical application of fluoride varnish |
1,838 |
1,837 |
$42K |
| D0274 |
Bitewings - four radiographic images |
1,149 |
1,148 |
$40K |
| D0603 |
|
2,114 |
2,112 |
$21K |
| D1330 |
|
3,312 |
3,308 |
$18K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
242 |
232 |
$13K |
| D0602 |
|
927 |
925 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
743 |
742 |
$7K |
| D0240 |
|
346 |
264 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
221 |
221 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
462 |
450 |
$5K |
| D0330 |
Panoramic radiographic image |
74 |
74 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
40 |
30 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
35 |
26 |
$2K |