| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,993 |
3,694 |
$191K |
| D1206 |
Topical application of fluoride varnish |
4,457 |
4,117 |
$108K |
| D0120 |
Periodic oral evaluation - established patient |
2,894 |
2,670 |
$79K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
317 |
141 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
447 |
424 |
$24K |
| D0274 |
Bitewings - four radiographic images |
569 |
527 |
$23K |
| D0140 |
Limited oral evaluation - problem focused |
348 |
317 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
319 |
302 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
226 |
211 |
$5K |
| D0272 |
Bitewings - two radiographic images |
138 |
129 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
29 |
15 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
85 |
78 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
159 |
89 |
$2K |
| D0330 |
Panoramic radiographic image |
17 |
16 |
$1K |
| D1351 |
Sealant - per tooth |
25 |
12 |
$1K |