| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,833 |
1,813 |
$55K |
| D1110 |
Prophylaxis - adult |
1,302 |
1,286 |
$46K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,393 |
2,371 |
$43K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
524 |
298 |
$37K |
| D0120 |
Periodic oral evaluation - established patient |
2,288 |
2,268 |
$37K |
| D9920 |
|
389 |
366 |
$27K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
623 |
292 |
$26K |
| D0274 |
Bitewings - four radiographic images |
1,187 |
1,171 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
854 |
840 |
$24K |
| D0210 |
Intraoral - complete series of radiographic images |
441 |
342 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
290 |
285 |
$6K |
| D0330 |
Panoramic radiographic image |
90 |
90 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
84 |
77 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
195 |
189 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
18 |
12 |
$2K |
| D1351 |
Sealant - per tooth |
34 |
13 |
$1K |
| D3120 |
|
21 |
12 |
$386.61 |