| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,454 |
7,308 |
$252K |
| D0120 |
Periodic oral evaluation - established patient |
10,166 |
9,925 |
$247K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,963 |
9,746 |
$210K |
| D1110 |
Prophylaxis - adult |
4,500 |
4,390 |
$194K |
| D0274 |
Bitewings - four radiographic images |
3,927 |
3,818 |
$103K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,013 |
732 |
$75K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,019 |
710 |
$61K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,787 |
1,750 |
$52K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,500 |
1,441 |
$44K |
| D0272 |
Bitewings - two radiographic images |
2,176 |
2,133 |
$38K |
| D0220 |
Intraoral - periapical first radiographic image |
2,918 |
2,816 |
$36K |
| D1351 |
Sealant - per tooth |
1,039 |
288 |
$29K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,820 |
1,434 |
$27K |
| D1206 |
Topical application of fluoride varnish |
894 |
879 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
629 |
616 |
$14K |
| D4346 |
|
15 |
13 |
$627.38 |
| D1330 |
|
1,532 |
1,525 |
$0.00 |
| D1999 |
|
4,752 |
4,570 |
$0.00 |
| D0431 |
|
35 |
35 |
$0.00 |