| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
9,761 |
9,377 |
$466K |
| D8670 |
Periodic orthodontic treatment visit |
1,642 |
1,476 |
$376K |
| D0120 |
Periodic oral evaluation - established patient |
11,350 |
10,950 |
$309K |
| D1206 |
Topical application of fluoride varnish |
12,261 |
11,857 |
$302K |
| D1110 |
Prophylaxis - adult |
1,467 |
1,415 |
$96K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
664 |
365 |
$71K |
| D0272 |
Bitewings - two radiographic images |
756 |
717 |
$21K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
619 |
510 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
56 |
55 |
$3K |
| D0274 |
Bitewings - four radiographic images |
51 |
51 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
21 |
12 |
$2K |
| D1351 |
Sealant - per tooth |
32 |
12 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
78 |
76 |
$1K |
| D8680 |
|
13 |
12 |
$1K |
| D1330 |
|
129 |
120 |
$0.00 |