| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
994 |
969 |
$23K |
| D1206 |
Topical application of fluoride varnish |
1,466 |
1,428 |
$17K |
| D1120 |
Prophylaxis - child |
712 |
698 |
$15K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
222 |
127 |
$8K |
| D0272 |
Bitewings - two radiographic images |
435 |
433 |
$4K |
| D1351 |
Sealant - per tooth |
253 |
80 |
$2K |
| D0274 |
Bitewings - four radiographic images |
91 |
90 |
$2K |
| D1110 |
Prophylaxis - adult |
26 |
26 |
$962.20 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
84 |
67 |
$638.75 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
32 |
24 |
$398.70 |
| D0230 |
Intraoral - periapical each additional radiographic image |
19 |
12 |
$170.20 |
| D0220 |
Intraoral - periapical first radiographic image |
13 |
13 |
$155.40 |
| D1330 |
|
32 |
32 |
$0.00 |
| D1310 |
|
12 |
12 |
$0.00 |
| D0190 |
|
1,157 |
1,131 |
$0.00 |
| D0191 |
|
71 |
71 |
$0.00 |