| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,207 |
1,111 |
$37K |
| D0120 |
Periodic oral evaluation - established patient |
1,171 |
1,067 |
$29K |
| D1351 |
Sealant - per tooth |
761 |
128 |
$20K |
| D1206 |
Topical application of fluoride varnish |
1,488 |
1,363 |
$19K |
| D0272 |
Bitewings - two radiographic images |
618 |
569 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
210 |
189 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
57 |
27 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
370 |
348 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
167 |
154 |
$4K |
| D1110 |
Prophylaxis - adult |
71 |
69 |
$4K |
| D0145 |
Oral evaluation for a patient under three years of age |
26 |
26 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
174 |
80 |
$2K |
| D0330 |
Panoramic radiographic image |
27 |
26 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
15 |
12 |
$1K |
| D0603 |
|
1,229 |
1,167 |
$0.00 |
| D0602 |
|
106 |
102 |
$0.00 |
| D0601 |
|
12 |
12 |
$0.00 |