| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,078 |
3,004 |
$140K |
| D0120 |
Periodic oral evaluation - established patient |
5,026 |
4,884 |
$126K |
| D1206 |
Topical application of fluoride varnish |
4,925 |
4,793 |
$92K |
| D0272 |
Bitewings - two radiographic images |
3,218 |
3,126 |
$70K |
| D1120 |
Prophylaxis - child |
1,021 |
1,004 |
$35K |
| D1351 |
Sealant - per tooth |
524 |
167 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
142 |
138 |
$11K |
| D0274 |
Bitewings - four radiographic images |
523 |
514 |
$11K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
145 |
64 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
238 |
231 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
65 |
50 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
50 |
28 |
$4K |
| D2140 |
|
55 |
24 |
$2K |
| D0330 |
Panoramic radiographic image |
48 |
43 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
34 |
31 |
$815.36 |
| D0140 |
Limited oral evaluation - problem focused |
33 |
28 |
$810.80 |