| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,789 |
3,773 |
$185K |
| D0120 |
Periodic oral evaluation - established patient |
6,620 |
6,603 |
$152K |
| D0274 |
Bitewings - four radiographic images |
5,467 |
5,454 |
$148K |
| D1120 |
Prophylaxis - child |
3,683 |
3,679 |
$127K |
| D1206 |
Topical application of fluoride varnish |
6,765 |
6,748 |
$110K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
617 |
502 |
$61K |
| D1351 |
Sealant - per tooth |
1,723 |
411 |
$50K |
| D0330 |
Panoramic radiographic image |
1,004 |
1,000 |
$49K |
| D0240 |
|
1,828 |
1,194 |
$34K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
213 |
160 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
1,637 |
1,629 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,108 |
964 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
59 |
50 |
$5K |
| D0272 |
Bitewings - two radiographic images |
225 |
225 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
83 |
82 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
38 |
38 |
$1K |