| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,841 |
2,792 |
$52K |
| D0120 |
Periodic oral evaluation - established patient |
3,455 |
3,388 |
$38K |
| D1206 |
Topical application of fluoride varnish |
3,528 |
3,454 |
$35K |
| D1110 |
Prophylaxis - adult |
1,130 |
1,102 |
$27K |
| D9630 |
|
2,014 |
1,984 |
$19K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
823 |
786 |
$15K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
202 |
140 |
$11K |
| D0272 |
Bitewings - two radiographic images |
834 |
816 |
$9K |
| D0330 |
Panoramic radiographic image |
142 |
142 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
337 |
337 |
$8K |
| D0274 |
Bitewings - four radiographic images |
507 |
496 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
256 |
253 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
166 |
154 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
34 |
26 |
$2K |
| D1351 |
Sealant - per tooth |
439 |
115 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
64 |
64 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
34 |
33 |
$203.42 |