| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,410 |
7,195 |
$297K |
| D0120 |
Periodic oral evaluation - established patient |
7,229 |
7,026 |
$199K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,526 |
6,324 |
$166K |
| D1351 |
Sealant - per tooth |
1,088 |
643 |
$47K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
497 |
447 |
$30K |
| D1206 |
Topical application of fluoride varnish |
857 |
846 |
$21K |
| D0274 |
Bitewings - four radiographic images |
960 |
928 |
$17K |
| D0272 |
Bitewings - two radiographic images |
1,696 |
1,645 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
611 |
584 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
338 |
310 |
$12K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
305 |
290 |
$11K |
| D0330 |
Panoramic radiographic image |
382 |
369 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
325 |
316 |
$2K |
| D0601 |
|
451 |
445 |
$129.00 |
| D0602 |
|
394 |
388 |
$0.00 |