| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,937 |
1,912 |
$87K |
| D1110 |
Prophylaxis - adult |
833 |
823 |
$67K |
| D1206 |
Topical application of fluoride varnish |
2,266 |
2,240 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
158 |
156 |
$10K |
| D1120 |
Prophylaxis - child |
1,418 |
1,400 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
275 |
261 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
133 |
88 |
$7K |
| D0274 |
Bitewings - four radiographic images |
879 |
871 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,718 |
1,649 |
$3K |
| D0272 |
Bitewings - two radiographic images |
664 |
653 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
1,775 |
1,750 |
$2K |
| D1330 |
|
2,278 |
2,249 |
$2K |
| D0601 |
|
210 |
210 |
$925.00 |
| D1351 |
Sealant - per tooth |
1,023 |
287 |
$912.00 |
| D0602 |
|
29 |
29 |
$272.00 |
| D0330 |
Panoramic radiographic image |
14 |
14 |
$129.00 |
| D0603 |
|
28 |
28 |
$2.00 |