| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
642 |
624 |
$38K |
| D1120 |
Prophylaxis - child |
987 |
963 |
$37K |
| D0120 |
Periodic oral evaluation - established patient |
1,160 |
1,137 |
$34K |
| D1110 |
Prophylaxis - adult |
545 |
532 |
$28K |
| D1208 |
Topical application of fluoride, excluding varnish |
942 |
928 |
$20K |
| D0272 |
Bitewings - two radiographic images |
634 |
612 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
261 |
249 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
679 |
620 |
$9K |
| D1206 |
Topical application of fluoride varnish |
116 |
114 |
$3K |
| D1351 |
Sealant - per tooth |
93 |
27 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
158 |
140 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
17 |
15 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
15 |
12 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
12 |
12 |
$440.76 |
| D0140 |
Limited oral evaluation - problem focused |
14 |
13 |
$210.00 |