| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,491 |
1,167 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
383 |
269 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
466 |
377 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
1,256 |
1,001 |
$3K |
| D0330 |
Panoramic radiographic image |
126 |
78 |
$788.45 |
| D1110 |
Prophylaxis - adult |
59 |
45 |
$510.60 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
345 |
236 |
$83.60 |
| D1206 |
Topical application of fluoride varnish |
1,716 |
1,344 |
$16.42 |
| D0220 |
Intraoral - periapical first radiographic image |
713 |
558 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
134 |
100 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
883 |
678 |
$0.00 |
| D1330 |
|
1,738 |
1,366 |
$0.00 |
| D1351 |
Sealant - per tooth |
338 |
59 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
110 |
40 |
$0.00 |