| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,756 |
1,679 |
$69K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,708 |
1,635 |
$42K |
| D0120 |
Periodic oral evaluation - established patient |
1,479 |
1,417 |
$39K |
| D1351 |
Sealant - per tooth |
604 |
240 |
$28K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
449 |
387 |
$22K |
| D0272 |
Bitewings - two radiographic images |
992 |
948 |
$9K |
| D2140 |
|
213 |
191 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
250 |
229 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
207 |
199 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
153 |
146 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
254 |
240 |
$1K |
| D2330 |
|
16 |
13 |
$449.80 |
| D0274 |
Bitewings - four radiographic images |
12 |
12 |
$202.80 |