| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,145 |
1,145 |
$51K |
| D1206 |
Topical application of fluoride varnish |
1,331 |
1,331 |
$41K |
| D0120 |
Periodic oral evaluation - established patient |
1,482 |
1,482 |
$37K |
| D1110 |
Prophylaxis - adult |
245 |
245 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,344 |
1,339 |
$9K |
| D1351 |
Sealant - per tooth |
370 |
90 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
1,457 |
1,447 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
88 |
44 |
$6K |
| D0272 |
Bitewings - two radiographic images |
600 |
600 |
$6K |
| D0274 |
Bitewings - four radiographic images |
493 |
493 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
112 |
106 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
102 |
93 |
$3K |
| D0602 |
|
59 |
59 |
$590.00 |
| D0603 |
|
52 |
52 |
$520.00 |
| D0601 |
|
26 |
26 |
$260.00 |