| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9920 |
|
661 |
624 |
$81K |
| D1120 |
Prophylaxis - child |
512 |
504 |
$15K |
| D1206 |
Topical application of fluoride varnish |
769 |
732 |
$14K |
| D1351 |
Sealant - per tooth |
146 |
120 |
$10K |
| D0120 |
Periodic oral evaluation - established patient |
477 |
471 |
$10K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
136 |
124 |
$6K |
| D0603 |
|
458 |
454 |
$5K |
| D0272 |
Bitewings - two radiographic images |
196 |
194 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
31 |
26 |
$3K |
| D1330 |
|
461 |
457 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
89 |
87 |
$2K |
| D1110 |
Prophylaxis - adult |
38 |
38 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
14 |
13 |
$970.92 |
| D0220 |
Intraoral - periapical first radiographic image |
112 |
108 |
$961.77 |
| D0230 |
Intraoral - periapical each additional radiographic image |
32 |
28 |
$405.97 |
| D0274 |
Bitewings - four radiographic images |
12 |
12 |
$358.72 |
| D9110 |
|
12 |
12 |
$344.76 |