| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,535 |
3,331 |
$111K |
| D1206 |
Topical application of fluoride varnish |
4,701 |
4,411 |
$93K |
| D0120 |
Periodic oral evaluation - established patient |
3,929 |
3,685 |
$80K |
| D1110 |
Prophylaxis - adult |
1,210 |
1,127 |
$48K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
431 |
381 |
$13K |
| D0272 |
Bitewings - two radiographic images |
489 |
447 |
$11K |
| D1351 |
Sealant - per tooth |
342 |
106 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
201 |
184 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
174 |
149 |
$5K |
| D0240 |
|
354 |
177 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
390 |
329 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
14 |
12 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
42 |
40 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
16 |
15 |
$721.50 |
| D0230 |
Intraoral - periapical each additional radiographic image |
42 |
13 |
$486.32 |