| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,157 |
3,128 |
$94K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,078 |
4,047 |
$74K |
| D0120 |
Periodic oral evaluation - established patient |
3,826 |
3,802 |
$66K |
| D1110 |
Prophylaxis - adult |
993 |
989 |
$37K |
| D0240 |
|
3,297 |
1,639 |
$34K |
| D0272 |
Bitewings - two radiographic images |
1,185 |
1,166 |
$22K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
235 |
124 |
$17K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
502 |
477 |
$15K |
| D0274 |
Bitewings - four radiographic images |
434 |
427 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
261 |
249 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
272 |
261 |
$3K |
| D1351 |
Sealant - per tooth |
37 |
12 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
43 |
39 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
56 |
24 |
$626.08 |