| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1206 |
Topical application of fluoride varnish |
3,131 |
3,106 |
$67K |
| D0120 |
Periodic oral evaluation - established patient |
2,616 |
2,600 |
$63K |
| D1110 |
Prophylaxis - adult |
1,545 |
1,532 |
$62K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
848 |
597 |
$61K |
| D1120 |
Prophylaxis - child |
1,590 |
1,590 |
$54K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,332 |
1,315 |
$38K |
| D0210 |
Intraoral - complete series of radiographic images |
655 |
644 |
$34K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
512 |
372 |
$31K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
377 |
279 |
$31K |
| D0330 |
Panoramic radiographic image |
789 |
785 |
$30K |
| D0274 |
Bitewings - four radiographic images |
1,103 |
1,099 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
2,143 |
2,085 |
$22K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
634 |
618 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
759 |
742 |
$17K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
42 |
29 |
$17K |
| D4346 |
|
363 |
358 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,485 |
1,444 |
$11K |
| D2954 |
|
163 |
123 |
$9K |
| D0272 |
Bitewings - two radiographic images |
398 |
393 |
$6K |
| D2332 |
|
18 |
12 |
$1K |
| D4342 |
|
40 |
12 |
$1K |