| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1208 |
Topical application of fluoride, excluding varnish |
937 |
809 |
$18K |
| D0120 |
Periodic oral evaluation - established patient |
775 |
655 |
$17K |
| D1120 |
Prophylaxis - child |
474 |
407 |
$14K |
| D1351 |
Sealant - per tooth |
560 |
88 |
$14K |
| D0330 |
Panoramic radiographic image |
247 |
203 |
$13K |
| D1110 |
Prophylaxis - adult |
305 |
252 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
114 |
80 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
224 |
171 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
54 |
28 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
330 |
270 |
$4K |
| D0272 |
Bitewings - two radiographic images |
136 |
120 |
$3K |
| D0274 |
Bitewings - four radiographic images |
84 |
61 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
50 |
39 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
198 |
46 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
57 |
51 |
$2K |