| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,355 |
3,235 |
$133K |
| D0120 |
Periodic oral evaluation - established patient |
3,481 |
3,350 |
$95K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,830 |
2,721 |
$71K |
| D1206 |
Topical application of fluoride varnish |
521 |
510 |
$13K |
| D1351 |
Sealant - per tooth |
302 |
216 |
$10K |
| D0272 |
Bitewings - two radiographic images |
495 |
472 |
$5K |
| D0274 |
Bitewings - four radiographic images |
85 |
84 |
$1K |
| D0330 |
Panoramic radiographic image |
39 |
39 |
$813.60 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
13 |
12 |
$524.45 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
13 |
13 |
$338.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
13 |
12 |
$273.65 |
| D0220 |
Intraoral - periapical first radiographic image |
13 |
12 |
$67.20 |
| D0601 |
|
366 |
359 |
$0.00 |
| D0602 |
|
246 |
238 |
$0.00 |