| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,138 |
4,130 |
$183K |
| D1206 |
Topical application of fluoride varnish |
4,466 |
4,460 |
$138K |
| D0120 |
Periodic oral evaluation - established patient |
4,023 |
4,019 |
$100K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
995 |
621 |
$68K |
| D1351 |
Sealant - per tooth |
2,734 |
500 |
$55K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
792 |
526 |
$43K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,272 |
1,212 |
$31K |
| D0140 |
Limited oral evaluation - problem focused |
393 |
383 |
$17K |
| D0603 |
|
1,513 |
1,510 |
$14K |
| D0272 |
Bitewings - two radiographic images |
1,371 |
1,370 |
$13K |
| D0602 |
|
1,108 |
1,105 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
338 |
338 |
$8K |
| D0330 |
Panoramic radiographic image |
181 |
181 |
$7K |
| D0274 |
Bitewings - four radiographic images |
584 |
580 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
1,255 |
1,249 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,048 |
1,039 |
$6K |
| D1110 |
Prophylaxis - adult |
126 |
126 |
$6K |
| D0601 |
|
525 |
523 |
$5K |
| D0240 |
|
135 |
135 |
$3K |
| D1330 |
|
413 |
407 |
$0.00 |
| D1310 |
|
70 |
68 |
$0.00 |