| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,294 |
3,218 |
$195K |
| D0120 |
Periodic oral evaluation - established patient |
4,380 |
4,280 |
$191K |
| D1206 |
Topical application of fluoride varnish |
4,174 |
4,076 |
$153K |
| D0274 |
Bitewings - four radiographic images |
2,782 |
2,722 |
$152K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
716 |
507 |
$129K |
| D1351 |
Sealant - per tooth |
2,431 |
949 |
$116K |
| D1110 |
Prophylaxis - adult |
1,027 |
1,006 |
$76K |
| D0272 |
Bitewings - two radiographic images |
1,532 |
1,505 |
$64K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
597 |
542 |
$38K |
| D0220 |
Intraoral - periapical first radiographic image |
738 |
729 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
120 |
120 |
$10K |
| D0330 |
Panoramic radiographic image |
82 |
82 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
136 |
135 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
273 |
217 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
32 |
27 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
69 |
69 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
38 |
37 |
$2K |
| D3120 |
|
25 |
24 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
12 |
12 |
$2K |