| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,429 |
2,297 |
$23K |
| D1206 |
Topical application of fluoride varnish |
2,659 |
2,481 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
1,955 |
1,787 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
596 |
558 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
395 |
190 |
$3K |
| D0603 |
|
379 |
378 |
$3K |
| D0272 |
Bitewings - two radiographic images |
1,109 |
1,016 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
133 |
78 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
591 |
504 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
31 |
31 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
57 |
57 |
$1K |
| D1351 |
Sealant - per tooth |
818 |
216 |
$1K |
| D0240 |
|
93 |
49 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
1,734 |
1,568 |
$747.54 |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,426 |
1,480 |
$691.07 |
| D0330 |
Panoramic radiographic image |
277 |
266 |
$649.88 |
| D1354 |
|
328 |
85 |
$307.92 |
| D0602 |
|
48 |
48 |
$264.00 |
| D0601 |
|
30 |
30 |
$220.00 |
| D0274 |
Bitewings - four radiographic images |
550 |
498 |
$153.90 |
| D1110 |
Prophylaxis - adult |
214 |
197 |
$48.97 |
| D1330 |
|
2,773 |
2,527 |
$0.01 |
| D1310 |
|
661 |
648 |
$0.00 |
| D0350 |
|
1,231 |
968 |
$0.00 |
| D1999 |
|
657 |
584 |
$0.00 |