| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,703 |
1,661 |
$48K |
| D1120 |
Prophylaxis - child |
1,137 |
1,103 |
$39K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
395 |
182 |
$39K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,299 |
1,695 |
$37K |
| D0274 |
Bitewings - four radiographic images |
1,085 |
1,061 |
$34K |
| D1110 |
Prophylaxis - adult |
659 |
644 |
$34K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,148 |
2,094 |
$31K |
| D1351 |
Sealant - per tooth |
872 |
217 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
1,808 |
1,766 |
$22K |
| D0145 |
Oral evaluation for a patient under three years of age |
69 |
68 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
205 |
198 |
$7K |
| D0330 |
Panoramic radiographic image |
135 |
133 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
89 |
85 |
$2K |
| D0272 |
Bitewings - two radiographic images |
83 |
80 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
23 |
17 |
$2K |
| D0603 |
|
2,687 |
2,603 |
$0.01 |