| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,256 |
1,138 |
$69K |
| D1120 |
Prophylaxis - child |
1,729 |
1,572 |
$65K |
| D0120 |
Periodic oral evaluation - established patient |
2,660 |
2,393 |
$64K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,827 |
2,551 |
$60K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,917 |
2,637 |
$58K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,352 |
1,190 |
$57K |
| D1351 |
Sealant - per tooth |
2,137 |
282 |
$51K |
| D0220 |
Intraoral - periapical first radiographic image |
3,001 |
2,690 |
$42K |
| D0272 |
Bitewings - two radiographic images |
1,441 |
1,284 |
$29K |
| D1320 |
|
762 |
670 |
$19K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
70 |
54 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
228 |
218 |
$8K |
| D2394 |
|
45 |
38 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$990.00 |