| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,789 |
2,341 |
$124K |
| D0120 |
Periodic oral evaluation - established patient |
3,521 |
3,149 |
$95K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
944 |
549 |
$84K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
761 |
474 |
$84K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,673 |
1,441 |
$71K |
| D1120 |
Prophylaxis - child |
1,916 |
1,874 |
$71K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,420 |
2,367 |
$51K |
| D0272 |
Bitewings - two radiographic images |
1,870 |
1,815 |
$42K |
| D0210 |
Intraoral - complete series of radiographic images |
500 |
433 |
$25K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
464 |
405 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
833 |
767 |
$11K |
| D0274 |
Bitewings - four radiographic images |
321 |
249 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
202 |
192 |
$6K |
| D1351 |
Sealant - per tooth |
47 |
14 |
$1K |
| D1206 |
Topical application of fluoride varnish |
48 |
45 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
35 |
27 |
$370.67 |
| D1999 |
|
66 |
31 |
$5.00 |