| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
10,446 |
9,806 |
$295K |
| D1120 |
Prophylaxis - child |
7,042 |
6,598 |
$293K |
| D1206 |
Topical application of fluoride varnish |
10,928 |
10,278 |
$259K |
| D1110 |
Prophylaxis - adult |
2,238 |
2,124 |
$130K |
| D0272 |
Bitewings - two radiographic images |
2,119 |
2,007 |
$31K |
| D1330 |
|
4,738 |
4,417 |
$28K |
| D1351 |
Sealant - per tooth |
755 |
114 |
$25K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
211 |
131 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
167 |
146 |
$8K |
| D0274 |
Bitewings - four radiographic images |
166 |
156 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
14 |
12 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
12 |
12 |
$525.12 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
13 |
13 |
$234.00 |