| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
6,793 |
6,741 |
$43K |
| D0120 |
Periodic oral evaluation - established patient |
7,049 |
6,996 |
$26K |
| D1206 |
Topical application of fluoride varnish |
6,634 |
6,580 |
$23K |
| D1354 |
|
4,094 |
1,309 |
$18K |
| D0272 |
Bitewings - two radiographic images |
3,276 |
3,244 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
3,766 |
3,719 |
$8K |
| D1351 |
Sealant - per tooth |
1,346 |
385 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,300 |
3,186 |
$5K |
| D1110 |
Prophylaxis - adult |
509 |
504 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
80 |
41 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
270 |
268 |
$2K |
| D0274 |
Bitewings - four radiographic images |
66 |
64 |
$308.23 |
| D1208 |
Topical application of fluoride, excluding varnish |
1,103 |
1,101 |
$246.61 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
98 |
94 |
$49.50 |
| D1999 |
|
1,251 |
1,189 |
$0.00 |