| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,346 |
3,224 |
$161K |
| D1206 |
Topical application of fluoride varnish |
3,490 |
3,365 |
$86K |
| D0120 |
Periodic oral evaluation - established patient |
3,077 |
2,972 |
$85K |
| D0272 |
Bitewings - two radiographic images |
1,377 |
1,322 |
$39K |
| D1110 |
Prophylaxis - adult |
192 |
186 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
157 |
150 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
314 |
305 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
89 |
86 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
269 |
187 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
24 |
12 |
$3K |
| D8670 |
Periodic orthodontic treatment visit |
34 |
15 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
26 |
12 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
65 |
57 |
$1K |