| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
744 |
719 |
$16K |
| D1120 |
Prophylaxis - child |
685 |
670 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
231 |
119 |
$11K |
| D1206 |
Topical application of fluoride varnish |
920 |
896 |
$11K |
| D0272 |
Bitewings - two radiographic images |
564 |
551 |
$7K |
| D1110 |
Prophylaxis - adult |
233 |
221 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
172 |
170 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
103 |
64 |
$4K |
| D0274 |
Bitewings - four radiographic images |
189 |
182 |
$4K |
| D1351 |
Sealant - per tooth |
96 |
43 |
$2K |
| D0330 |
Panoramic radiographic image |
54 |
53 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
45 |
43 |
$913.60 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
17 |
14 |
$391.00 |
| D0220 |
Intraoral - periapical first radiographic image |
12 |
12 |
$92.16 |