| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0350 |
|
6,480 |
2,166 |
$622K |
| D1120 |
Prophylaxis - child |
3,840 |
3,763 |
$134K |
| D0120 |
Periodic oral evaluation - established patient |
3,340 |
3,309 |
$82K |
| D1206 |
Topical application of fluoride varnish |
4,091 |
4,013 |
$81K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,871 |
1,825 |
$65K |
| D1351 |
Sealant - per tooth |
874 |
222 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
717 |
708 |
$30K |
| D0220 |
Intraoral - periapical first radiographic image |
2,194 |
2,158 |
$28K |
| D9219 |
|
344 |
344 |
$14K |
| D1110 |
Prophylaxis - adult |
229 |
229 |
$12K |
| D9110 |
|
193 |
191 |
$11K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
52 |
26 |
$6K |
| D1354 |
|
200 |
40 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
176 |
172 |
$6K |
| D0240 |
|
55 |
55 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
58 |
58 |
$1K |
| D0270 |
|
76 |
76 |
$1K |