| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,150 |
2,041 |
$76K |
| D1206 |
Topical application of fluoride varnish |
1,646 |
1,593 |
$56K |
| D0120 |
Periodic oral evaluation - established patient |
2,086 |
2,004 |
$35K |
| D1110 |
Prophylaxis - adult |
672 |
658 |
$26K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
455 |
227 |
$25K |
| D1351 |
Sealant - per tooth |
1,267 |
397 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
796 |
769 |
$21K |
| D0274 |
Bitewings - four radiographic images |
746 |
729 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
1,408 |
1,326 |
$16K |
| D0330 |
Panoramic radiographic image |
362 |
356 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
379 |
367 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
196 |
124 |
$8K |
| D0272 |
Bitewings - two radiographic images |
452 |
419 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
612 |
540 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
114 |
108 |
$2K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
20 |
12 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
49 |
43 |
$1K |
| D7111 |
|
21 |
12 |
$1K |
| D1999 |
|
194 |
137 |
$0.00 |