| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1206 |
Topical application of fluoride varnish |
4,749 |
4,364 |
$191K |
| D1120 |
Prophylaxis - child |
4,395 |
4,019 |
$190K |
| D0120 |
Periodic oral evaluation - established patient |
4,085 |
3,777 |
$177K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,342 |
831 |
$166K |
| D0272 |
Bitewings - two radiographic images |
3,203 |
2,940 |
$90K |
| D0220 |
Intraoral - periapical first radiographic image |
2,653 |
2,331 |
$46K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,761 |
1,856 |
$38K |
| D9248 |
|
215 |
163 |
$35K |
| D0274 |
Bitewings - four radiographic images |
740 |
684 |
$35K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
523 |
412 |
$30K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
455 |
406 |
$26K |
| D1110 |
Prophylaxis - adult |
74 |
71 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
41 |
24 |
$4K |
| D1351 |
Sealant - per tooth |
41 |
13 |
$1K |