| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
497 |
464 |
$12K |
| D1120 |
Prophylaxis - child |
350 |
325 |
$9K |
| D0274 |
Bitewings - four radiographic images |
347 |
322 |
$9K |
| D1110 |
Prophylaxis - adult |
189 |
177 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
82 |
40 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
391 |
365 |
$5K |
| D1351 |
Sealant - per tooth |
162 |
35 |
$3K |
| D0272 |
Bitewings - two radiographic images |
58 |
54 |
$1K |
| D1206 |
Topical application of fluoride varnish |
63 |
62 |
$649.24 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
15 |
15 |
$395.30 |
| D0602 |
|
68 |
62 |
$0.00 |
| D0601 |
|
424 |
383 |
$0.00 |
| D0603 |
|
14 |
13 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
45 |
12 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
17 |
15 |
$0.00 |
| D1999 |
|
20 |
20 |
$0.00 |