| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,062 |
6,893 |
$195K |
| D0120 |
Periodic oral evaluation - established patient |
5,539 |
5,347 |
$143K |
| D1206 |
Topical application of fluoride varnish |
7,405 |
7,185 |
$121K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,198 |
2,116 |
$98K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
601 |
442 |
$64K |
| D0272 |
Bitewings - two radiographic images |
2,377 |
2,308 |
$44K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
397 |
258 |
$32K |
| D0240 |
|
1,196 |
643 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
511 |
483 |
$19K |
| D1351 |
Sealant - per tooth |
582 |
159 |
$15K |
| D0330 |
Panoramic radiographic image |
280 |
273 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
602 |
578 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
292 |
102 |
$3K |
| D1110 |
Prophylaxis - adult |
87 |
85 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
31 |
25 |
$1K |