| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,181 |
1,140 |
$2K |
| D1206 |
Topical application of fluoride varnish |
2,085 |
2,027 |
$2K |
| D1320 |
|
1,513 |
1,349 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
1,318 |
1,278 |
$979.51 |
| D1321 |
|
878 |
792 |
$950.29 |
| D0240 |
|
559 |
540 |
$458.24 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
248 |
210 |
$396.59 |
| D0220 |
Intraoral - periapical first radiographic image |
515 |
504 |
$256.78 |
| D1354 |
|
87 |
38 |
$235.44 |
| D1110 |
Prophylaxis - adult |
170 |
165 |
$232.56 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
39 |
37 |
$89.46 |
| D1351 |
Sealant - per tooth |
46 |
16 |
$62.92 |
| D0272 |
Bitewings - two radiographic images |
83 |
79 |
$48.52 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
29 |
15 |
$46.25 |
| D0274 |
Bitewings - four radiographic images |
38 |
38 |
$24.56 |
| D0603 |
|
428 |
364 |
$0.00 |
| D0602 |
|
78 |
66 |
$0.00 |