| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,321 |
4,176 |
$128K |
| D0120 |
Periodic oral evaluation - established patient |
4,935 |
4,775 |
$96K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,276 |
5,089 |
$80K |
| D0272 |
Bitewings - two radiographic images |
2,745 |
2,654 |
$49K |
| D1999 |
|
2,241 |
2,002 |
$40K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,679 |
1,550 |
$32K |
| D0330 |
Panoramic radiographic image |
588 |
565 |
$31K |
| D1110 |
Prophylaxis - adult |
788 |
751 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
2,354 |
2,218 |
$26K |
| D1354 |
|
782 |
229 |
$21K |
| D1351 |
Sealant - per tooth |
772 |
290 |
$15K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
90 |
66 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
236 |
220 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
69 |
52 |
$4K |
| D9248 |
|
206 |
188 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
228 |
128 |
$2K |
| D9920 |
|
16 |
13 |
$0.00 |
| D9630 |
|
18 |
18 |
$0.00 |