| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,696 |
2,522 |
$138K |
| D0120 |
Periodic oral evaluation - established patient |
2,894 |
2,722 |
$116K |
| D1206 |
Topical application of fluoride varnish |
3,282 |
3,081 |
$103K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
741 |
633 |
$49K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
144 |
83 |
$28K |
| D0272 |
Bitewings - two radiographic images |
745 |
695 |
$26K |
| D1110 |
Prophylaxis - adult |
344 |
323 |
$25K |
| D1351 |
Sealant - per tooth |
252 |
91 |
$11K |
| D0330 |
Panoramic radiographic image |
128 |
118 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
61 |
55 |
$4K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
17 |
12 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
14 |
13 |
$910.28 |
| D0220 |
Intraoral - periapical first radiographic image |
19 |
18 |
$409.92 |
| D0603 |
|
2,621 |
2,473 |
$0.00 |
| D0602 |
|
384 |
357 |
$0.00 |
| D1330 |
|
421 |
388 |
$0.00 |
| D1999 |
|
288 |
280 |
$0.00 |