| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,080 |
3,027 |
$91K |
| D0120 |
Periodic oral evaluation - established patient |
3,414 |
3,358 |
$70K |
| D1206 |
Topical application of fluoride varnish |
3,656 |
3,583 |
$54K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
469 |
276 |
$27K |
| D0272 |
Bitewings - two radiographic images |
1,235 |
1,199 |
$19K |
| D0350 |
|
926 |
905 |
$14K |
| D1351 |
Sealant - per tooth |
672 |
215 |
$13K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
700 |
652 |
$12K |
| D1110 |
Prophylaxis - adult |
338 |
327 |
$12K |
| D0330 |
Panoramic radiographic image |
198 |
197 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
930 |
911 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
330 |
311 |
$8K |
| D0274 |
Bitewings - four radiographic images |
237 |
227 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
81 |
55 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
453 |
417 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
33 |
31 |
$642.40 |
| D0210 |
Intraoral - complete series of radiographic images |
20 |
13 |
$0.00 |