| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,197 |
2,136 |
$75K |
| D0120 |
Periodic oral evaluation - established patient |
3,058 |
2,962 |
$74K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
540 |
391 |
$73K |
| D1110 |
Prophylaxis - adult |
1,217 |
1,156 |
$56K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,439 |
1,276 |
$46K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
418 |
336 |
$45K |
| D1206 |
Topical application of fluoride varnish |
1,354 |
1,321 |
$30K |
| D8660 |
|
212 |
212 |
$29K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,771 |
1,691 |
$20K |
| D0272 |
Bitewings - two radiographic images |
876 |
846 |
$18K |
| D0274 |
Bitewings - four radiographic images |
554 |
542 |
$17K |
| D1351 |
Sealant - per tooth |
345 |
93 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
553 |
533 |
$7K |
| D0330 |
Panoramic radiographic image |
122 |
122 |
$6K |
| D0340 |
|
44 |
44 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
193 |
193 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
31 |
31 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
34 |
25 |
$1K |
| D0350 |
|
14 |
14 |
$436.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
12 |
12 |
$383.40 |