| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
5,216 |
5,184 |
$269K |
| D0120 |
Periodic oral evaluation - established patient |
7,369 |
7,284 |
$211K |
| D1206 |
Topical application of fluoride varnish |
7,112 |
7,066 |
$187K |
| D8670 |
Periodic orthodontic treatment visit |
714 |
684 |
$179K |
| D1110 |
Prophylaxis - adult |
1,809 |
1,768 |
$118K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
247 |
143 |
$28K |
| D0272 |
Bitewings - two radiographic images |
868 |
862 |
$26K |
| D0274 |
Bitewings - four radiographic images |
400 |
396 |
$17K |
| D1351 |
Sealant - per tooth |
320 |
100 |
$13K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
221 |
198 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
28 |
12 |
$3K |
| D8680 |
|
12 |
12 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
50 |
50 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
13 |
13 |
$754.00 |
| D1354 |
|
29 |
12 |
$405.00 |