| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,847 |
3,753 |
$172K |
| D1206 |
Topical application of fluoride varnish |
3,862 |
3,766 |
$137K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,270 |
817 |
$66K |
| D0274 |
Bitewings - four radiographic images |
2,447 |
2,391 |
$57K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,673 |
1,636 |
$53K |
| D0120 |
Periodic oral evaluation - established patient |
1,587 |
1,550 |
$28K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
673 |
458 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
3,452 |
3,326 |
$28K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,385 |
1,279 |
$25K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,185 |
3,446 |
$24K |
| D0350 |
|
3,108 |
2,306 |
$12K |
| D7111 |
|
374 |
282 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
377 |
361 |
$11K |
| D1351 |
Sealant - per tooth |
405 |
119 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
134 |
110 |
$7K |
| D0603 |
|
1,781 |
1,744 |
$7K |
| D0272 |
Bitewings - two radiographic images |
351 |
345 |
$6K |
| D0145 |
Oral evaluation for a patient under three years of age |
158 |
154 |
$3K |
| D1999 |
|
113 |
113 |
$2K |
| D9999 |
Unspecified adjunctive procedure, by report |
133 |
133 |
$2K |
| D0602 |
|
297 |
288 |
$1K |
| D2940 |
|
33 |
12 |
$934.44 |
| D0999 |
Unspecified diagnostic procedure, by report |
20 |
20 |
$600.00 |