| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,150 |
2,100 |
$36K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,207 |
2,149 |
$33K |
| D1120 |
Prophylaxis - child |
1,694 |
1,651 |
$33K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
359 |
243 |
$18K |
| D1110 |
Prophylaxis - adult |
568 |
539 |
$17K |
| D0274 |
Bitewings - four radiographic images |
402 |
391 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
222 |
207 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
114 |
87 |
$6K |
| D0272 |
Bitewings - two radiographic images |
542 |
532 |
$5K |
| D0330 |
Panoramic radiographic image |
121 |
117 |
$5K |
| D1351 |
Sealant - per tooth |
201 |
59 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
103 |
100 |
$2K |
| D2931 |
|
14 |
12 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
120 |
109 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
308 |
292 |
$1K |