| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,549 |
1,505 |
$52K |
| D0120 |
Periodic oral evaluation - established patient |
1,338 |
1,305 |
$36K |
| D1351 |
Sealant - per tooth |
1,472 |
326 |
$35K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
395 |
135 |
$32K |
| D1206 |
Topical application of fluoride varnish |
1,789 |
1,740 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,047 |
309 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
271 |
264 |
$9K |
| D0272 |
Bitewings - two radiographic images |
406 |
388 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
506 |
486 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
37 |
24 |
$3K |
| D9248 |
|
40 |
37 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
101 |
94 |
$2K |
| D1330 |
|
14 |
14 |
$12.25 |
| D0603 |
|
1,194 |
1,059 |
$0.00 |
| D0601 |
|
980 |
945 |
$0.00 |
| D0602 |
|
209 |
172 |
$0.00 |