| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,657 |
1,498 |
$79K |
| D1351 |
Sealant - per tooth |
2,937 |
557 |
$74K |
| D1120 |
Prophylaxis - child |
1,629 |
1,473 |
$53K |
| D0120 |
Periodic oral evaluation - established patient |
2,190 |
2,049 |
$52K |
| D1206 |
Topical application of fluoride varnish |
2,212 |
2,033 |
$47K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
767 |
486 |
$46K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,282 |
1,087 |
$43K |
| D0220 |
Intraoral - periapical first radiographic image |
2,255 |
2,016 |
$26K |
| D0274 |
Bitewings - four radiographic images |
773 |
717 |
$25K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,034 |
1,592 |
$20K |
| D0140 |
Limited oral evaluation - problem focused |
372 |
349 |
$14K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
487 |
436 |
$13K |
| D0272 |
Bitewings - two radiographic images |
591 |
541 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
280 |
200 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
103 |
77 |
$8K |
| D0330 |
Panoramic radiographic image |
79 |
74 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
183 |
137 |
$3K |