| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,762 |
3,727 |
$107K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,047 |
578 |
$104K |
| D1351 |
Sealant - per tooth |
3,310 |
679 |
$90K |
| D1110 |
Prophylaxis - adult |
1,610 |
1,595 |
$87K |
| D1120 |
Prophylaxis - child |
2,401 |
2,375 |
$86K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,379 |
4,334 |
$63K |
| D0274 |
Bitewings - four radiographic images |
1,360 |
1,348 |
$46K |
| D0220 |
Intraoral - periapical first radiographic image |
3,691 |
3,633 |
$45K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,447 |
3,365 |
$39K |
| D0210 |
Intraoral - complete series of radiographic images |
547 |
543 |
$37K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
402 |
260 |
$31K |
| D0272 |
Bitewings - two radiographic images |
1,350 |
1,337 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
290 |
286 |
$10K |
| D0145 |
Oral evaluation for a patient under three years of age |
68 |
68 |
$10K |
| D1330 |
|
118 |
110 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
13 |
12 |
$350.35 |
| D0602 |
|
3,142 |
3,110 |
$0.00 |
| D0603 |
|
1,554 |
1,541 |
$0.00 |