| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,860 |
1,788 |
$52K |
| D1206 |
Topical application of fluoride varnish |
2,015 |
1,915 |
$50K |
| D0120 |
Periodic oral evaluation - established patient |
1,297 |
1,235 |
$31K |
| D1999 |
|
1,333 |
1,197 |
$13K |
| D0272 |
Bitewings - two radiographic images |
716 |
693 |
$10K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
197 |
174 |
$6K |
| D1351 |
Sealant - per tooth |
205 |
43 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
114 |
114 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
248 |
243 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
16 |
12 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
145 |
135 |
$774.88 |
| D0145 |
Oral evaluation for a patient under three years of age |
16 |
16 |
$701.84 |