| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
7,086 |
7,026 |
$174K |
| D1120 |
Prophylaxis - child |
4,769 |
4,728 |
$165K |
| D1206 |
Topical application of fluoride varnish |
8,032 |
7,959 |
$160K |
| D1110 |
Prophylaxis - adult |
2,803 |
2,782 |
$136K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
785 |
433 |
$104K |
| D0272 |
Bitewings - two radiographic images |
2,235 |
2,218 |
$47K |
| D1351 |
Sealant - per tooth |
1,074 |
314 |
$38K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,006 |
927 |
$32K |
| D0274 |
Bitewings - four radiographic images |
712 |
708 |
$22K |
| D0330 |
Panoramic radiographic image |
278 |
270 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
277 |
277 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
114 |
114 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
629 |
621 |
$8K |
| D0145 |
Oral evaluation for a patient under three years of age |
184 |
180 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
21 |
12 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
78 |
78 |
$1K |