| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,768 |
1,595 |
$42K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
452 |
212 |
$40K |
| D1110 |
Prophylaxis - adult |
893 |
770 |
$38K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
554 |
249 |
$36K |
| D1120 |
Prophylaxis - child |
926 |
839 |
$27K |
| D0274 |
Bitewings - four radiographic images |
895 |
770 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,836 |
1,641 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
2,002 |
1,790 |
$20K |
| D1351 |
Sealant - per tooth |
865 |
215 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,910 |
1,643 |
$17K |
| D0272 |
Bitewings - two radiographic images |
812 |
740 |
$16K |
| D0145 |
Oral evaluation for a patient under three years of age |
58 |
53 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
215 |
180 |
$6K |
| D0330 |
Panoramic radiographic image |
156 |
130 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
15 |
15 |
$947.20 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
13 |
12 |
$354.21 |
| D0603 |
|
1,823 |
1,412 |
$0.00 |
| D0602 |
|
905 |
871 |
$0.00 |
| D0601 |
|
15 |
14 |
$0.00 |