| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,899 |
1,877 |
$75K |
| D0120 |
Periodic oral evaluation - established patient |
2,037 |
2,003 |
$59K |
| D1206 |
Topical application of fluoride varnish |
2,332 |
2,300 |
$56K |
| D0272 |
Bitewings - two radiographic images |
1,063 |
1,057 |
$36K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
223 |
137 |
$30K |
| D1110 |
Prophylaxis - adult |
365 |
356 |
$23K |
| D0274 |
Bitewings - four radiographic images |
524 |
513 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
289 |
289 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
295 |
292 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
40 |
30 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
82 |
82 |
$4K |
| D0350 |
|
65 |
64 |
$3K |
| D0330 |
Panoramic radiographic image |
48 |
48 |
$3K |
| D1351 |
Sealant - per tooth |
50 |
12 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
45 |
40 |
$599.38 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
15 |
12 |
$438.40 |
| D0601 |
|
412 |
408 |
$0.95 |
| D0603 |
|
1,407 |
1,396 |
$0.93 |
| D0602 |
|
17 |
17 |
$0.02 |
| D1330 |
|
87 |
87 |
$0.00 |