| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,206 |
2,176 |
$41K |
| D1110 |
Prophylaxis - adult |
1,176 |
1,158 |
$40K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,618 |
2,576 |
$39K |
| D1120 |
Prophylaxis - child |
1,393 |
1,372 |
$38K |
| D0272 |
Bitewings - two radiographic images |
2,151 |
2,115 |
$37K |
| D0330 |
Panoramic radiographic image |
753 |
733 |
$35K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,029 |
915 |
$20K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
83 |
52 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
196 |
191 |
$4K |
| D1351 |
Sealant - per tooth |
47 |
16 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
99 |
89 |
$880.00 |