| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,058 |
1,979 |
$54K |
| D1120 |
Prophylaxis - child |
1,346 |
1,289 |
$44K |
| D1110 |
Prophylaxis - adult |
674 |
651 |
$34K |
| D1206 |
Topical application of fluoride varnish |
1,947 |
1,868 |
$26K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
265 |
170 |
$24K |
| D0274 |
Bitewings - four radiographic images |
678 |
656 |
$22K |
| D0272 |
Bitewings - two radiographic images |
757 |
729 |
$16K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
611 |
554 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
1,395 |
1,297 |
$15K |
| D1351 |
Sealant - per tooth |
568 |
150 |
$12K |
| D0350 |
|
850 |
778 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
104 |
76 |
$7K |
| D0330 |
Panoramic radiographic image |
165 |
155 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
322 |
289 |
$3K |
| D1999 |
|
521 |
452 |
$0.00 |
| D0603 |
|
2,225 |
2,175 |
$0.00 |