| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,561 |
1,523 |
$56K |
| D0120 |
Periodic oral evaluation - established patient |
1,938 |
1,904 |
$47K |
| D1206 |
Topical application of fluoride varnish |
1,475 |
1,428 |
$32K |
| D1110 |
Prophylaxis - adult |
582 |
576 |
$25K |
| D0272 |
Bitewings - two radiographic images |
1,024 |
1,004 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
688 |
685 |
$15K |
| D0274 |
Bitewings - four radiographic images |
315 |
314 |
$10K |
| D0603 |
|
995 |
993 |
$10K |
| D1351 |
Sealant - per tooth |
324 |
71 |
$10K |
| D1330 |
|
1,490 |
1,486 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
264 |
251 |
$7K |
| D0240 |
|
247 |
152 |
$4K |
| D0602 |
|
406 |
405 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
49 |
47 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
23 |
15 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
151 |
151 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
65 |
62 |
$659.41 |
| D0330 |
Panoramic radiographic image |
15 |
15 |
$650.45 |
| D0140 |
Limited oral evaluation - problem focused |
16 |
16 |
$241.50 |
| D1999 |
|
198 |
197 |
$0.50 |