| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
8,285 |
8,124 |
$354K |
| D1206 |
Topical application of fluoride varnish |
9,644 |
9,459 |
$234K |
| D0120 |
Periodic oral evaluation - established patient |
7,479 |
7,341 |
$216K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
561 |
554 |
$29K |
| D0272 |
Bitewings - two radiographic images |
1,881 |
1,846 |
$28K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
668 |
602 |
$12K |
| D1330 |
|
1,799 |
1,761 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
82 |
50 |
$9K |
| D1351 |
Sealant - per tooth |
301 |
63 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
109 |
106 |
$5K |
| D1110 |
Prophylaxis - adult |
36 |
36 |
$2K |
| D0330 |
Panoramic radiographic image |
41 |
41 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
32 |
32 |
$1K |
| D0274 |
Bitewings - four radiographic images |
12 |
12 |
$240.70 |
| D0220 |
Intraoral - periapical first radiographic image |
12 |
12 |
$99.00 |