| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,172 |
3,490 |
$132K |
| D0120 |
Periodic oral evaluation - established patient |
6,902 |
6,074 |
$117K |
| D1120 |
Prophylaxis - child |
2,779 |
2,485 |
$69K |
| D1999 |
|
3,597 |
2,853 |
$57K |
| D1206 |
Topical application of fluoride varnish |
2,693 |
2,362 |
$53K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
650 |
285 |
$43K |
| D0330 |
Panoramic radiographic image |
1,075 |
912 |
$40K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,143 |
2,744 |
$39K |
| D0274 |
Bitewings - four radiographic images |
1,616 |
1,379 |
$32K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,782 |
738 |
$24K |
| D0272 |
Bitewings - two radiographic images |
799 |
715 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
1,444 |
1,142 |
$12K |
| D1351 |
Sealant - per tooth |
366 |
96 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
329 |
235 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
66 |
26 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
60 |
41 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
37 |
27 |
$672.00 |
| D0140 |
Limited oral evaluation - problem focused |
13 |
12 |
$334.95 |