| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1206 |
Topical application of fluoride varnish |
685 |
639 |
$21K |
| D1120 |
Prophylaxis - child |
478 |
460 |
$19K |
| D0120 |
Periodic oral evaluation - established patient |
522 |
485 |
$10K |
| D1110 |
Prophylaxis - adult |
239 |
203 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
366 |
339 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
250 |
204 |
$4K |
| D0274 |
Bitewings - four radiographic images |
165 |
151 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
88 |
49 |
$3K |
| D1351 |
Sealant - per tooth |
266 |
66 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
76 |
45 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
450 |
354 |
$2K |
| D0272 |
Bitewings - two radiographic images |
130 |
125 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
94 |
93 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
24 |
15 |
$1K |
| D0603 |
|
367 |
331 |
$1K |
| D2140 |
|
18 |
13 |
$816.00 |
| D0210 |
Intraoral - complete series of radiographic images |
15 |
15 |
$648.34 |
| D0602 |
|
133 |
127 |
$600.00 |
| D1353 |
|
36 |
13 |
$524.80 |
| D1208 |
Topical application of fluoride, excluding varnish |
16 |
16 |
$112.64 |
| D1354 |
|
69 |
18 |
$12.30 |
| D9630 |
|
34 |
34 |
$10.25 |