| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,764 |
1,670 |
$81K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,316 |
2,196 |
$34K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,339 |
1,266 |
$34K |
| D0272 |
Bitewings - two radiographic images |
1,085 |
1,028 |
$19K |
| D0120 |
Periodic oral evaluation - established patient |
1,013 |
965 |
$18K |
| D1110 |
Prophylaxis - adult |
384 |
367 |
$18K |
| D0330 |
Panoramic radiographic image |
435 |
415 |
$16K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
214 |
131 |
$13K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
298 |
268 |
$10K |
| D1351 |
Sealant - per tooth |
518 |
141 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
100 |
81 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
99 |
95 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
69 |
66 |
$709.80 |
| D9986 |
|
325 |
272 |
$39.00 |