| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,737 |
2,717 |
$98K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
838 |
340 |
$83K |
| D0120 |
Periodic oral evaluation - established patient |
2,592 |
2,582 |
$74K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,770 |
3,711 |
$63K |
| D0145 |
Oral evaluation for a patient under three years of age |
437 |
432 |
$60K |
| D0272 |
Bitewings - two radiographic images |
2,695 |
2,678 |
$55K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,626 |
3,600 |
$52K |
| D0220 |
Intraoral - periapical first radiographic image |
4,091 |
4,036 |
$38K |
| D1351 |
Sealant - per tooth |
1,133 |
312 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
524 |
515 |
$17K |
| D1110 |
Prophylaxis - adult |
228 |
227 |
$12K |
| D0330 |
Panoramic radiographic image |
448 |
443 |
$11K |
| D9248 |
|
80 |
79 |
$10K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
315 |
293 |
$8K |
| D0274 |
Bitewings - four radiographic images |
245 |
244 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
61 |
61 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
35 |
25 |
$3K |
| D0603 |
|
4,952 |
4,890 |
$0.00 |