| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
12,808 |
12,555 |
$308K |
| D1110 |
Prophylaxis - adult |
6,891 |
6,751 |
$295K |
| D1120 |
Prophylaxis - child |
7,170 |
7,013 |
$238K |
| D0274 |
Bitewings - four radiographic images |
6,057 |
5,942 |
$163K |
| D1206 |
Topical application of fluoride varnish |
7,489 |
7,328 |
$151K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,998 |
5,876 |
$124K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,690 |
988 |
$116K |
| D0330 |
Panoramic radiographic image |
2,556 |
2,503 |
$100K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,167 |
3,599 |
$65K |
| D0220 |
Intraoral - periapical first radiographic image |
4,529 |
4,360 |
$55K |
| D0272 |
Bitewings - two radiographic images |
2,377 |
2,336 |
$42K |
| D0210 |
Intraoral - complete series of radiographic images |
536 |
529 |
$32K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,105 |
1,077 |
$31K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
532 |
351 |
$29K |
| D2332 |
|
191 |
124 |
$16K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
544 |
455 |
$15K |
| D1354 |
|
2,234 |
388 |
$13K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
155 |
100 |
$12K |
| D0145 |
Oral evaluation for a patient under three years of age |
124 |
124 |
$3K |