| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,725 |
1,665 |
$40K |
| D1120 |
Prophylaxis - child |
1,499 |
1,447 |
$31K |
| D0274 |
Bitewings - four radiographic images |
1,320 |
1,276 |
$27K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,552 |
1,643 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,911 |
1,839 |
$22K |
| D1351 |
Sealant - per tooth |
1,078 |
341 |
$20K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
288 |
178 |
$19K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
841 |
722 |
$18K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
356 |
227 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
1,798 |
1,726 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
325 |
314 |
$12K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
141 |
65 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
198 |
110 |
$10K |
| D1110 |
Prophylaxis - adult |
330 |
311 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
177 |
160 |
$2K |
| D0330 |
Panoramic radiographic image |
32 |
31 |
$974.72 |
| D1206 |
Topical application of fluoride varnish |
52 |
52 |
$716.46 |
| D0272 |
Bitewings - two radiographic images |
46 |
45 |
$664.00 |