| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
5,265 |
5,224 |
$140K |
| D1120 |
Prophylaxis - child |
4,214 |
4,180 |
$118K |
| D1206 |
Topical application of fluoride varnish |
5,472 |
5,427 |
$91K |
| D1110 |
Prophylaxis - adult |
1,231 |
1,221 |
$48K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
920 |
875 |
$42K |
| D0272 |
Bitewings - two radiographic images |
1,585 |
1,569 |
$30K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
192 |
122 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
132 |
130 |
$6K |
| D0274 |
Bitewings - four radiographic images |
162 |
162 |
$5K |
| D1351 |
Sealant - per tooth |
150 |
50 |
$4K |
| D0330 |
Panoramic radiographic image |
37 |
37 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
16 |
13 |
$1K |
| D0240 |
|
15 |
15 |
$263.10 |