| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,190 |
2,132 |
$50K |
| D0120 |
Periodic oral evaluation - established patient |
2,866 |
2,784 |
$47K |
| D1206 |
Topical application of fluoride varnish |
2,975 |
2,891 |
$40K |
| D1110 |
Prophylaxis - adult |
711 |
690 |
$22K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
322 |
151 |
$18K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
779 |
689 |
$16K |
| D0272 |
Bitewings - two radiographic images |
1,038 |
1,004 |
$12K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
110 |
53 |
$10K |
| D0274 |
Bitewings - four radiographic images |
484 |
471 |
$8K |
| D0330 |
Panoramic radiographic image |
124 |
122 |
$4K |
| D1351 |
Sealant - per tooth |
87 |
37 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
17 |
17 |
$440.13 |
| D0220 |
Intraoral - periapical first radiographic image |
43 |
42 |
$409.20 |
| D1999 |
|
26 |
26 |
$0.00 |