| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
5,266 |
5,180 |
$128K |
| D1120 |
Prophylaxis - child |
4,780 |
4,694 |
$107K |
| D1206 |
Topical application of fluoride varnish |
4,991 |
4,884 |
$87K |
| D0272 |
Bitewings - two radiographic images |
2,412 |
2,347 |
$48K |
| D1330 |
|
936 |
923 |
$24K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
381 |
218 |
$13K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
975 |
895 |
$12K |
| D1110 |
Prophylaxis - adult |
246 |
245 |
$11K |
| D0274 |
Bitewings - four radiographic images |
284 |
276 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
646 |
624 |
$8K |
| D9920 |
|
238 |
224 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
184 |
120 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
334 |
230 |
$3K |
| D1351 |
Sealant - per tooth |
105 |
38 |
$2K |
| D0330 |
Panoramic radiographic image |
27 |
27 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12 |
12 |
$0.00 |
| D9985 |
|
1,128 |
989 |
$0.00 |