| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1206 |
Topical application of fluoride varnish |
6,451 |
6,160 |
$294K |
| D1120 |
Prophylaxis - child |
5,751 |
5,509 |
$288K |
| D0120 |
Periodic oral evaluation - established patient |
4,359 |
4,164 |
$124K |
| D0272 |
Bitewings - two radiographic images |
2,874 |
2,703 |
$53K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,011 |
504 |
$49K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,455 |
1,400 |
$43K |
| D1351 |
Sealant - per tooth |
1,477 |
262 |
$28K |
| D1110 |
Prophylaxis - adult |
594 |
558 |
$23K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,270 |
1,111 |
$22K |
| D0330 |
Panoramic radiographic image |
250 |
244 |
$8K |
| D0274 |
Bitewings - four radiographic images |
295 |
285 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
385 |
353 |
$5K |
| D8660 |
|
58 |
51 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
28 |
24 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
34 |
24 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
222 |
119 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
40 |
38 |
$1K |
| D0340 |
|
25 |
25 |
$942.77 |
| D0350 |
|
45 |
39 |
$697.00 |
| D1354 |
|
41 |
16 |
$529.72 |
| D0145 |
Oral evaluation for a patient under three years of age |
25 |
25 |
$410.00 |
| D1330 |
|
20 |
20 |
$0.00 |