| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,744 |
1,494 |
$44K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,293 |
1,052 |
$38K |
| D1206 |
Topical application of fluoride varnish |
1,459 |
1,255 |
$31K |
| D0330 |
Panoramic radiographic image |
826 |
705 |
$27K |
| D0140 |
Limited oral evaluation - problem focused |
421 |
300 |
$13K |
| D1351 |
Sealant - per tooth |
445 |
99 |
$11K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
90 |
48 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
237 |
231 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
159 |
141 |
$2K |
| D0274 |
Bitewings - four radiographic images |
84 |
80 |
$2K |
| D0272 |
Bitewings - two radiographic images |
129 |
96 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
157 |
141 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$756.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
13 |
12 |
$0.00 |