| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,311 |
4,050 |
$210K |
| D0120 |
Periodic oral evaluation - established patient |
4,603 |
4,322 |
$93K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,754 |
5,386 |
$84K |
| D1110 |
Prophylaxis - adult |
1,455 |
1,370 |
$71K |
| D0272 |
Bitewings - two radiographic images |
2,061 |
1,920 |
$36K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,084 |
1,004 |
$27K |
| D0330 |
Panoramic radiographic image |
705 |
651 |
$25K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,478 |
1,564 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
2,093 |
1,909 |
$20K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
615 |
545 |
$15K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
129 |
65 |
$7K |
| D0274 |
Bitewings - four radiographic images |
146 |
129 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
67 |
38 |
$4K |
| D1999 |
|
494 |
436 |
$0.00 |
| D9986 |
|
44 |
26 |
$0.00 |