| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,677 |
1,623 |
$42K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
357 |
142 |
$41K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
403 |
205 |
$41K |
| D1110 |
Prophylaxis - adult |
1,102 |
1,054 |
$40K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,560 |
1,515 |
$25K |
| D1120 |
Prophylaxis - child |
792 |
779 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
473 |
455 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
1,162 |
1,080 |
$17K |
| D0274 |
Bitewings - four radiographic images |
474 |
451 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
991 |
921 |
$11K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
125 |
105 |
$5K |
| D2394 |
|
26 |
15 |
$4K |
| D0272 |
Bitewings - two radiographic images |
146 |
145 |
$3K |
| D0330 |
Panoramic radiographic image |
44 |
44 |
$2K |