| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,797 |
4,595 |
$233K |
| D1206 |
Topical application of fluoride varnish |
5,134 |
4,904 |
$127K |
| D0120 |
Periodic oral evaluation - established patient |
4,149 |
3,943 |
$113K |
| D0272 |
Bitewings - two radiographic images |
1,149 |
1,119 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
344 |
339 |
$20K |
| D1351 |
Sealant - per tooth |
371 |
119 |
$14K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
656 |
561 |
$13K |
| D1110 |
Prophylaxis - adult |
122 |
114 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
192 |
183 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
79 |
76 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
37 |
26 |
$3K |
| D0274 |
Bitewings - four radiographic images |
27 |
27 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
32 |
14 |
$368.00 |