| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,167 |
3,033 |
$46K |
| D0120 |
Periodic oral evaluation - established patient |
2,692 |
2,566 |
$28K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,448 |
2,338 |
$19K |
| D0272 |
Bitewings - two radiographic images |
1,989 |
1,896 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
2,408 |
2,299 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,201 |
2,025 |
$9K |
| D0240 |
|
1,326 |
665 |
$7K |
| D0274 |
Bitewings - four radiographic images |
312 |
301 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
470 |
434 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
109 |
63 |
$3K |
| D1206 |
Topical application of fluoride varnish |
544 |
526 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
144 |
143 |
$2K |
| D0330 |
Panoramic radiographic image |
114 |
113 |
$2K |
| D1110 |
Prophylaxis - adult |
59 |
57 |
$1K |
| D1351 |
Sealant - per tooth |
46 |
12 |
$702.78 |
| D0145 |
Oral evaluation for a patient under three years of age |
12 |
12 |
$186.96 |
| D1999 |
|
156 |
149 |
$11.82 |
| D1330 |
|
1,658 |
1,507 |
$0.00 |
| D0601 |
|
14 |
14 |
$0.00 |