| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,807 |
1,789 |
$85K |
| D1310 |
|
1,240 |
1,238 |
$55K |
| D0120 |
Periodic oral evaluation - established patient |
741 |
739 |
$49K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
725 |
724 |
$46K |
| D1206 |
Topical application of fluoride varnish |
1,768 |
1,750 |
$40K |
| D0145 |
Oral evaluation for a patient under three years of age |
346 |
346 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,201 |
1,348 |
$15K |
| D0603 |
|
670 |
668 |
$9K |
| D0272 |
Bitewings - two radiographic images |
791 |
790 |
$8K |
| D1351 |
Sealant - per tooth |
211 |
57 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
134 |
123 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
476 |
473 |
$5K |
| D0602 |
|
317 |
317 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
53 |
28 |
$3K |
| D0601 |
|
30 |
30 |
$435.00 |