| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,036 |
3,984 |
$145K |
| D0120 |
Periodic oral evaluation - established patient |
3,825 |
3,796 |
$101K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,435 |
549 |
$93K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,892 |
5,509 |
$67K |
| D0220 |
Intraoral - periapical first radiographic image |
5,782 |
5,616 |
$67K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,085 |
4,012 |
$58K |
| D1110 |
Prophylaxis - adult |
1,388 |
1,357 |
$58K |
| D0274 |
Bitewings - four radiographic images |
2,102 |
2,074 |
$56K |
| D0272 |
Bitewings - two radiographic images |
2,620 |
2,581 |
$49K |
| D0330 |
Panoramic radiographic image |
1,289 |
1,242 |
$48K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,595 |
1,557 |
$47K |
| D1206 |
Topical application of fluoride varnish |
1,683 |
1,666 |
$40K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
230 |
103 |
$19K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
311 |
280 |
$6K |
| D1351 |
Sealant - per tooth |
63 |
13 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
17 |
12 |
$825.24 |
| D0601 |
|
82 |
71 |
$0.00 |
| D0602 |
|
3,328 |
3,181 |
$0.00 |
| D0603 |
|
535 |
480 |
$0.00 |