| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1206 |
Topical application of fluoride varnish |
16,726 |
16,434 |
$1.13M |
| D1110 |
Prophylaxis - adult |
7,779 |
7,653 |
$1.01M |
| D0274 |
Bitewings - four radiographic images |
9,639 |
9,483 |
$896K |
| D0330 |
Panoramic radiographic image |
4,546 |
4,489 |
$754K |
| D1120 |
Prophylaxis - child |
5,323 |
5,253 |
$489K |
| D0220 |
Intraoral - periapical first radiographic image |
12,466 |
12,090 |
$482K |
| D0120 |
Periodic oral evaluation - established patient |
6,069 |
5,987 |
$455K |
| D1330 |
|
4,681 |
4,619 |
$340K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,898 |
5,549 |
$310K |
| D4910 |
|
1,385 |
1,374 |
$302K |
| D0140 |
Limited oral evaluation - problem focused |
2,123 |
2,039 |
$207K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,534 |
1,518 |
$197K |
| D0272 |
Bitewings - two radiographic images |
2,413 |
2,377 |
$137K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
578 |
525 |
$54K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
117 |
78 |
$43K |
| D0270 |
|
801 |
774 |
$27K |
| D0460 |
|
325 |
314 |
$26K |
| D9310 |
|
72 |
72 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
49 |
36 |
$11K |
| D1354 |
|
171 |
35 |
$8K |
| D0145 |
Oral evaluation for a patient under three years of age |
51 |
51 |
$6K |
| D1351 |
Sealant - per tooth |
89 |
28 |
$6K |