| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
540 |
456 |
$21K |
| D1206 |
Topical application of fluoride varnish |
474 |
412 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
185 |
165 |
$5K |
| D0272 |
Bitewings - two radiographic images |
274 |
228 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
231 |
182 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
101 |
68 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
83 |
81 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
141 |
129 |
$2K |
| D0330 |
Panoramic radiographic image |
62 |
57 |
$2K |
| D1351 |
Sealant - per tooth |
62 |
16 |
$1K |
| D9248 |
|
18 |
15 |
$1K |
| D0602 |
|
541 |
403 |
$1K |
| D0603 |
|
151 |
143 |
$575.00 |
| D0191 |
|
21 |
20 |
$163.84 |
| D1330 |
|
182 |
171 |
$0.00 |