| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,392 |
7,172 |
$318K |
| D0120 |
Periodic oral evaluation - established patient |
10,785 |
10,499 |
$318K |
| D1206 |
Topical application of fluoride varnish |
11,518 |
11,209 |
$285K |
| D1110 |
Prophylaxis - adult |
3,252 |
3,185 |
$197K |
| D1330 |
|
5,778 |
5,607 |
$35K |
| D1351 |
Sealant - per tooth |
958 |
158 |
$32K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
192 |
107 |
$23K |
| D0274 |
Bitewings - four radiographic images |
602 |
594 |
$14K |
| D0272 |
Bitewings - two radiographic images |
437 |
414 |
$6K |
| D0330 |
Panoramic radiographic image |
131 |
122 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
119 |
113 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
30 |
24 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
91 |
78 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12 |
12 |
$676.08 |
| D0220 |
Intraoral - periapical first radiographic image |
12 |
12 |
$141.84 |