| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,914 |
3,912 |
$158K |
| D0120 |
Periodic oral evaluation - established patient |
3,858 |
3,855 |
$124K |
| D1206 |
Topical application of fluoride varnish |
3,832 |
3,829 |
$104K |
| D0272 |
Bitewings - two radiographic images |
1,639 |
1,637 |
$39K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
170 |
119 |
$21K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
36 |
14 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
321 |
319 |
$6K |
| D1351 |
Sealant - per tooth |
137 |
51 |
$4K |
| D1110 |
Prophylaxis - adult |
37 |
37 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
18 |
13 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
25 |
25 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
28 |
24 |
$382.51 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
519 |
500 |
$0.00 |