| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,658 |
3,639 |
$180K |
| D0120 |
Periodic oral evaluation - established patient |
2,270 |
2,257 |
$163K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,024 |
1,020 |
$70K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,655 |
3,636 |
$66K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
857 |
440 |
$57K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,091 |
3,226 |
$32K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
508 |
245 |
$27K |
| D9430 |
|
796 |
730 |
$25K |
| D1351 |
Sealant - per tooth |
622 |
186 |
$23K |
| D0272 |
Bitewings - two radiographic images |
1,964 |
1,952 |
$23K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
502 |
442 |
$20K |
| D1310 |
|
221 |
219 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
769 |
748 |
$9K |
| D0350 |
|
886 |
377 |
$8K |
| D0145 |
Oral evaluation for a patient under three years of age |
112 |
112 |
$8K |
| D0330 |
Panoramic radiographic image |
238 |
238 |
$7K |
| D0274 |
Bitewings - four radiographic images |
279 |
279 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
91 |
91 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
17 |
14 |
$1K |
| D0603 |
|
54 |
52 |
$795.00 |
| D0601 |
|
12 |
12 |
$180.00 |