| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,347 |
2,340 |
$70K |
| D0220 |
Intraoral - periapical first radiographic image |
4,002 |
3,968 |
$60K |
| D0120 |
Periodic oral evaluation - established patient |
2,748 |
2,743 |
$57K |
| D1110 |
Prophylaxis - adult |
1,193 |
1,185 |
$53K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,628 |
2,917 |
$50K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,241 |
3,231 |
$48K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
386 |
155 |
$35K |
| D0330 |
Panoramic radiographic image |
671 |
670 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,019 |
1,010 |
$31K |
| D0274 |
Bitewings - four radiographic images |
977 |
977 |
$29K |
| D0240 |
|
1,401 |
1,393 |
$24K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
441 |
396 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
116 |
39 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
24 |
13 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
93 |
93 |
$3K |
| D0272 |
Bitewings - two radiographic images |
102 |
102 |
$2K |