| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,840 |
3,740 |
$173K |
| D0120 |
Periodic oral evaluation - established patient |
6,194 |
5,995 |
$132K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,745 |
1,092 |
$126K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,985 |
4,826 |
$97K |
| D1120 |
Prophylaxis - child |
2,746 |
2,634 |
$83K |
| D0274 |
Bitewings - four radiographic images |
2,075 |
2,009 |
$74K |
| D0330 |
Panoramic radiographic image |
1,132 |
1,087 |
$56K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,866 |
1,743 |
$47K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
898 |
554 |
$41K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
563 |
538 |
$20K |
| D0140 |
Limited oral evaluation - problem focused |
344 |
326 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
484 |
457 |
$5K |
| D0272 |
Bitewings - two radiographic images |
242 |
238 |
$3K |
| D2331 |
|
14 |
12 |
$2K |
| D2330 |
|
17 |
12 |
$1K |
| D1351 |
Sealant - per tooth |
51 |
12 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
19 |
13 |
$154.00 |