| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,262 |
2,112 |
$66K |
| D0120 |
Periodic oral evaluation - established patient |
2,217 |
2,082 |
$47K |
| D1206 |
Topical application of fluoride varnish |
2,408 |
2,254 |
$46K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,041 |
969 |
$28K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
381 |
230 |
$22K |
| D1351 |
Sealant - per tooth |
489 |
187 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
988 |
912 |
$10K |
| D0330 |
Panoramic radiographic image |
198 |
196 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
824 |
326 |
$6K |
| D0272 |
Bitewings - two radiographic images |
404 |
397 |
$6K |
| D0274 |
Bitewings - four radiographic images |
189 |
182 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
60 |
39 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
124 |
100 |
$3K |
| D1110 |
Prophylaxis - adult |
41 |
40 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
27 |
27 |
$556.20 |
| D1330 |
|
2,363 |
2,206 |
$0.00 |