| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,631 |
1,606 |
$66K |
| D1351 |
Sealant - per tooth |
1,509 |
192 |
$60K |
| D0120 |
Periodic oral evaluation - established patient |
1,723 |
1,694 |
$55K |
| D1206 |
Topical application of fluoride varnish |
2,226 |
2,190 |
$55K |
| D1110 |
Prophylaxis - adult |
809 |
795 |
$43K |
| D0272 |
Bitewings - two radiographic images |
597 |
584 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
387 |
381 |
$17K |
| D0274 |
Bitewings - four radiographic images |
411 |
403 |
$15K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
54 |
26 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
96 |
94 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
149 |
147 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
40 |
38 |
$2K |
| D1330 |
|
12 |
12 |
$300.00 |