| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
5,787 |
5,684 |
$257K |
| D1206 |
Topical application of fluoride varnish |
5,790 |
5,690 |
$207K |
| D1351 |
Sealant - per tooth |
5,099 |
906 |
$108K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,132 |
3,075 |
$99K |
| D0274 |
Bitewings - four radiographic images |
3,404 |
3,347 |
$77K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,101 |
732 |
$57K |
| D0220 |
Intraoral - periapical first radiographic image |
4,068 |
3,950 |
$43K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,864 |
5,271 |
$43K |
| D0120 |
Periodic oral evaluation - established patient |
1,575 |
1,556 |
$40K |
| D0330 |
Panoramic radiographic image |
844 |
829 |
$30K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
860 |
826 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
322 |
221 |
$12K |
| D0999 |
Unspecified diagnostic procedure, by report |
168 |
168 |
$6K |
| D0145 |
Oral evaluation for a patient under three years of age |
239 |
233 |
$5K |
| D9999 |
Unspecified adjunctive procedure, by report |
157 |
157 |
$4K |
| D1110 |
Prophylaxis - adult |
87 |
87 |
$4K |
| D0272 |
Bitewings - two radiographic images |
185 |
182 |
$3K |
| D0350 |
|
1,801 |
1,647 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
40 |
39 |
$1K |
| D0603 |
|
708 |
703 |
$978.00 |
| D0602 |
|
385 |
382 |
$593.00 |
| D0601 |
|
96 |
92 |
$80.00 |