| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
463 |
451 |
$16K |
| D1120 |
Prophylaxis - child |
386 |
378 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
184 |
172 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
533 |
523 |
$10K |
| D4346 |
|
75 |
75 |
$9K |
| D1351 |
Sealant - per tooth |
323 |
82 |
$7K |
| D0274 |
Bitewings - four radiographic images |
200 |
200 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
517 |
511 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
414 |
372 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
46 |
34 |
$3K |
| D9110 |
|
57 |
54 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
124 |
124 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
79 |
79 |
$2K |
| D0272 |
Bitewings - two radiographic images |
101 |
101 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
16 |
12 |
$1K |
| D2394 |
|
12 |
12 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
42 |
41 |
$1K |
| D0270 |
|
105 |
99 |
$1K |
| D1110 |
Prophylaxis - adult |
19 |
17 |
$721.31 |