| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1206 |
Topical application of fluoride varnish |
4,920 |
4,638 |
$47K |
| D1120 |
Prophylaxis - child |
4,244 |
4,021 |
$46K |
| D0120 |
Periodic oral evaluation - established patient |
4,263 |
4,009 |
$42K |
| D0272 |
Bitewings - two radiographic images |
3,058 |
2,902 |
$21K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,419 |
843 |
$18K |
| D9248 |
|
352 |
270 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
2,471 |
2,274 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
511 |
495 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,066 |
1,813 |
$8K |
| D0274 |
Bitewings - four radiographic images |
1,020 |
929 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
724 |
576 |
$5K |
| D1110 |
Prophylaxis - adult |
296 |
251 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
191 |
119 |
$420.22 |
| D1351 |
Sealant - per tooth |
161 |
49 |
$0.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
43 |
28 |
$0.00 |