| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,093 |
890 |
$24K |
| D0120 |
Periodic oral evaluation - established patient |
1,126 |
847 |
$19K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
168 |
86 |
$17K |
| D1206 |
Topical application of fluoride varnish |
749 |
711 |
$16K |
| D0272 |
Bitewings - two radiographic images |
502 |
434 |
$7K |
| D1351 |
Sealant - per tooth |
217 |
42 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
180 |
172 |
$5K |
| D0274 |
Bitewings - four radiographic images |
164 |
164 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
396 |
385 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
428 |
293 |
$4K |
| D1110 |
Prophylaxis - adult |
60 |
60 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
30 |
26 |
$2K |
| D0330 |
Panoramic radiographic image |
63 |
63 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
243 |
156 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
12 |
12 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
17 |
17 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12 |
12 |
$488.76 |
| D1330 |
|
170 |
170 |
$0.00 |
| D0603 |
|
1,247 |
989 |
$0.00 |
| D1310 |
|
172 |
172 |
$0.00 |