| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,892 |
3,866 |
$107K |
| D1120 |
Prophylaxis - child |
2,451 |
2,444 |
$87K |
| D1110 |
Prophylaxis - adult |
1,259 |
1,249 |
$65K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
711 |
433 |
$63K |
| D1206 |
Topical application of fluoride varnish |
3,813 |
3,800 |
$54K |
| D0145 |
Oral evaluation for a patient under three years of age |
297 |
295 |
$40K |
| D0220 |
Intraoral - periapical first radiographic image |
3,491 |
3,460 |
$40K |
| D0274 |
Bitewings - four radiographic images |
1,492 |
1,481 |
$39K |
| D0272 |
Bitewings - two radiographic images |
1,856 |
1,851 |
$36K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,093 |
3,046 |
$33K |
| D0330 |
Panoramic radiographic image |
623 |
615 |
$17K |
| D1351 |
Sealant - per tooth |
497 |
108 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
142 |
142 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
280 |
273 |
$9K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
309 |
295 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
34 |
26 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
24 |
24 |
$525.08 |
| D0603 |
|
5,900 |
5,844 |
$0.00 |