| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,410 |
2,344 |
$91K |
| D1206 |
Topical application of fluoride varnish |
2,487 |
2,417 |
$47K |
| D0120 |
Periodic oral evaluation - established patient |
1,831 |
1,782 |
$46K |
| D0272 |
Bitewings - two radiographic images |
1,230 |
1,195 |
$25K |
| D1351 |
Sealant - per tooth |
740 |
215 |
$16K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
86 |
29 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
258 |
248 |
$10K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
367 |
338 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
589 |
564 |
$7K |
| D0240 |
|
633 |
245 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
488 |
311 |
$4K |
| D0145 |
Oral evaluation for a patient under three years of age |
142 |
134 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
41 |
25 |
$3K |
| D1354 |
|
132 |
47 |
$2K |
| D0274 |
Bitewings - four radiographic images |
69 |
65 |
$2K |
| D1110 |
Prophylaxis - adult |
50 |
45 |
$2K |
| D0602 |
|
806 |
773 |
$0.00 |
| D0603 |
|
1,311 |
1,272 |
$0.00 |
| D0601 |
|
90 |
88 |
$0.00 |