| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,655 |
4,461 |
$79K |
| D0120 |
Periodic oral evaluation - established patient |
4,254 |
4,064 |
$44K |
| D1206 |
Topical application of fluoride varnish |
5,209 |
4,993 |
$40K |
| D0272 |
Bitewings - two radiographic images |
2,570 |
2,446 |
$23K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
53 |
25 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
575 |
526 |
$3K |
| D0240 |
|
132 |
102 |
$1K |
| D0274 |
Bitewings - four radiographic images |
25 |
25 |
$398.64 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
13 |
13 |
$397.45 |
| D1999 |
|
527 |
523 |
$0.00 |
| D1110 |
Prophylaxis - adult |
51 |
48 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
12 |
12 |
$0.00 |
| D1351 |
Sealant - per tooth |
43 |
14 |
$0.00 |
| D1330 |
|
877 |
716 |
$0.00 |