| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,306 |
4,161 |
$170K |
| D0120 |
Periodic oral evaluation - established patient |
3,862 |
3,731 |
$105K |
| D1206 |
Topical application of fluoride varnish |
2,275 |
2,172 |
$56K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
932 |
915 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
433 |
419 |
$11K |
| D0272 |
Bitewings - two radiographic images |
1,079 |
1,044 |
$11K |
| D1351 |
Sealant - per tooth |
135 |
82 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
263 |
259 |
$5K |
| D1354 |
|
225 |
102 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
52 |
51 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
27 |
25 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
132 |
119 |
$703.43 |