| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,305 |
1,204 |
$42K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
491 |
183 |
$42K |
| D1351 |
Sealant - per tooth |
1,329 |
262 |
$34K |
| D0120 |
Periodic oral evaluation - established patient |
1,233 |
1,131 |
$32K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,786 |
1,419 |
$27K |
| D0272 |
Bitewings - two radiographic images |
927 |
854 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,371 |
1,338 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
1,681 |
1,529 |
$19K |
| D0145 |
Oral evaluation for a patient under three years of age |
84 |
82 |
$11K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
410 |
348 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
130 |
124 |
$4K |
| D1110 |
Prophylaxis - adult |
13 |
12 |
$548.80 |
| D0274 |
Bitewings - four radiographic images |
12 |
12 |
$415.32 |
| D1206 |
Topical application of fluoride varnish |
27 |
15 |
$217.56 |
| D0602 |
|
2,105 |
2,037 |
$0.00 |
| D1999 |
|
450 |
403 |
$0.00 |