| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,072 |
4,032 |
$170K |
| D0120 |
Periodic oral evaluation - established patient |
5,944 |
5,840 |
$125K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,597 |
4,545 |
$108K |
| D1110 |
Prophylaxis - adult |
2,133 |
2,071 |
$85K |
| D0272 |
Bitewings - two radiographic images |
1,474 |
1,457 |
$36K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
276 |
156 |
$25K |
| D9920 |
|
301 |
290 |
$24K |
| D1351 |
Sealant - per tooth |
492 |
131 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
150 |
91 |
$11K |
| D0274 |
Bitewings - four radiographic images |
335 |
330 |
$9K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
444 |
409 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
467 |
440 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
88 |
87 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
100 |
94 |
$4K |
| D0330 |
Panoramic radiographic image |
42 |
42 |
$3K |
| D1999 |
|
200 |
188 |
$0.00 |