| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,546 |
4,545 |
$176K |
| D0120 |
Periodic oral evaluation - established patient |
4,769 |
4,768 |
$146K |
| D1206 |
Topical application of fluoride varnish |
5,011 |
5,009 |
$129K |
| D0272 |
Bitewings - two radiographic images |
2,146 |
2,146 |
$51K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
270 |
182 |
$23K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
233 |
100 |
$19K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
173 |
99 |
$19K |
| D1351 |
Sealant - per tooth |
520 |
175 |
$15K |
| D1110 |
Prophylaxis - adult |
244 |
244 |
$11K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
54 |
27 |
$10K |
| D0240 |
|
479 |
287 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
95 |
94 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
88 |
88 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
216 |
216 |
$4K |
| D0330 |
Panoramic radiographic image |
49 |
49 |
$3K |
| D0274 |
Bitewings - four radiographic images |
55 |
55 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
624 |
622 |
$0.00 |