| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,230 |
3,185 |
$136K |
| D0120 |
Periodic oral evaluation - established patient |
3,440 |
3,385 |
$100K |
| D1351 |
Sealant - per tooth |
2,905 |
973 |
$96K |
| D1206 |
Topical application of fluoride varnish |
3,786 |
3,727 |
$94K |
| D9941 |
|
608 |
595 |
$62K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
312 |
234 |
$37K |
| D0330 |
Panoramic radiographic image |
647 |
635 |
$27K |
| D1110 |
Prophylaxis - adult |
401 |
390 |
$23K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
235 |
175 |
$21K |
| D0272 |
Bitewings - two radiographic images |
1,236 |
1,216 |
$18K |
| D0274 |
Bitewings - four radiographic images |
593 |
581 |
$13K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
679 |
654 |
$12K |
| D1330 |
|
1,868 |
1,847 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
190 |
190 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
79 |
77 |
$3K |
| D0240 |
|
42 |
42 |
$756.00 |
| D3120 |
|
15 |
12 |
$525.00 |
| D0220 |
Intraoral - periapical first radiographic image |
45 |
45 |
$405.00 |