| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,946 |
1,855 |
$78K |
| D1351 |
Sealant - per tooth |
1,382 |
669 |
$64K |
| D0120 |
Periodic oral evaluation - established patient |
2,276 |
2,161 |
$61K |
| D1206 |
Topical application of fluoride varnish |
1,851 |
1,776 |
$47K |
| D1208 |
Topical application of fluoride, excluding varnish |
146 |
130 |
$4K |
| D0274 |
Bitewings - four radiographic images |
138 |
125 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
43 |
32 |
$2K |
| D2140 |
|
25 |
18 |
$740.40 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
18 |
17 |
$468.00 |
| D0330 |
Panoramic radiographic image |
18 |
16 |
$406.80 |
| D0272 |
Bitewings - two radiographic images |
35 |
33 |
$329.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
15 |
13 |
$315.75 |
| D0220 |
Intraoral - periapical first radiographic image |
16 |
16 |
$89.60 |
| D0603 |
|
214 |
204 |
$0.00 |
| D0602 |
|
290 |
280 |
$0.00 |
| D0601 |
|
867 |
847 |
$0.00 |