| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,369 |
4,365 |
$212K |
| D0120 |
Periodic oral evaluation - established patient |
4,547 |
4,543 |
$152K |
| D1206 |
Topical application of fluoride varnish |
2,536 |
2,530 |
$79K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,854 |
1,854 |
$55K |
| D0272 |
Bitewings - two radiographic images |
2,586 |
2,586 |
$39K |
| D1351 |
Sealant - per tooth |
1,278 |
175 |
$34K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
439 |
272 |
$31K |
| D0220 |
Intraoral - periapical first radiographic image |
3,217 |
3,203 |
$24K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
815 |
761 |
$20K |
| D0274 |
Bitewings - four radiographic images |
1,020 |
1,018 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,899 |
2,896 |
$16K |
| D0603 |
|
1,362 |
1,360 |
$13K |
| D0602 |
|
613 |
612 |
$6K |
| D1110 |
Prophylaxis - adult |
94 |
94 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
112 |
112 |
$3K |
| D0330 |
Panoramic radiographic image |
24 |
24 |
$1K |
| D0601 |
|
12 |
12 |
$120.00 |
| D8670 |
Periodic orthodontic treatment visit |
18 |
18 |
$81.16 |