| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
2,275 |
2,256 |
$140K |
| D1120 |
Prophylaxis - child |
2,474 |
2,462 |
$96K |
| D0120 |
Periodic oral evaluation - established patient |
2,703 |
2,685 |
$82K |
| D1110 |
Prophylaxis - adult |
1,269 |
1,257 |
$68K |
| D0272 |
Bitewings - two radiographic images |
1,968 |
1,956 |
$46K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,099 |
2,086 |
$46K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,022 |
940 |
$39K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
647 |
634 |
$30K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
289 |
207 |
$26K |
| D1351 |
Sealant - per tooth |
713 |
213 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
1,485 |
1,445 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
839 |
621 |
$12K |
| D1206 |
Topical application of fluoride varnish |
374 |
373 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
77 |
73 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
13 |
12 |
$1K |