| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1206 |
Topical application of fluoride varnish |
3,021 |
2,681 |
$51K |
| D1110 |
Prophylaxis - adult |
1,384 |
1,233 |
$51K |
| D0120 |
Periodic oral evaluation - established patient |
2,013 |
1,796 |
$41K |
| D0330 |
Panoramic radiographic image |
1,162 |
1,047 |
$39K |
| D0274 |
Bitewings - four radiographic images |
1,756 |
1,567 |
$33K |
| D1120 |
Prophylaxis - child |
1,057 |
961 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,038 |
933 |
$26K |
| D4346 |
|
472 |
418 |
$18K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
222 |
154 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
1,221 |
1,076 |
$13K |
| D1351 |
Sealant - per tooth |
486 |
147 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
208 |
142 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,314 |
623 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
280 |
258 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
163 |
135 |
$4K |
| D0272 |
Bitewings - two radiographic images |
95 |
90 |
$2K |