| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,180 |
2,092 |
$74K |
| D1206 |
Topical application of fluoride varnish |
2,833 |
2,711 |
$60K |
| D0120 |
Periodic oral evaluation - established patient |
2,294 |
2,211 |
$57K |
| D0272 |
Bitewings - two radiographic images |
1,636 |
1,569 |
$37K |
| D1110 |
Prophylaxis - adult |
591 |
567 |
$31K |
| D0603 |
|
2,016 |
1,917 |
$20K |
| D0274 |
Bitewings - four radiographic images |
569 |
552 |
$19K |
| D0330 |
Panoramic radiographic image |
273 |
255 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
294 |
279 |
$10K |
| D1310 |
|
233 |
228 |
$10K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
282 |
274 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
408 |
382 |
$7K |
| D1330 |
|
233 |
228 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
37 |
26 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
67 |
40 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
660 |
196 |
$3K |
| D1351 |
Sealant - per tooth |
166 |
29 |
$3K |
| D0601 |
|
222 |
217 |
$2K |