| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,245 |
2,244 |
$88K |
| D0120 |
Periodic oral evaluation - established patient |
1,960 |
1,959 |
$62K |
| D1206 |
Topical application of fluoride varnish |
2,092 |
2,091 |
$55K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
311 |
178 |
$37K |
| D0272 |
Bitewings - two radiographic images |
858 |
857 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
143 |
143 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
258 |
255 |
$5K |
| D1354 |
|
63 |
41 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
14 |
12 |
$1K |
| D1351 |
Sealant - per tooth |
36 |
13 |
$860.70 |
| D0230 |
Intraoral - periapical each additional radiographic image |
61 |
44 |
$812.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
52 |
51 |
$0.00 |