| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,850 |
2,331 |
$64K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
674 |
353 |
$63K |
| D0120 |
Periodic oral evaluation - established patient |
2,330 |
1,844 |
$43K |
| D1206 |
Topical application of fluoride varnish |
1,884 |
1,664 |
$39K |
| D0330 |
Panoramic radiographic image |
488 |
442 |
$24K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
282 |
173 |
$21K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
794 |
683 |
$20K |
| D0272 |
Bitewings - two radiographic images |
1,190 |
955 |
$17K |
| D1351 |
Sealant - per tooth |
707 |
115 |
$16K |
| D0274 |
Bitewings - four radiographic images |
578 |
511 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
363 |
276 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
873 |
625 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
479 |
425 |
$5K |
| D0145 |
Oral evaluation for a patient under three years of age |
125 |
111 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
99 |
90 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
323 |
247 |
$3K |
| D0603 |
|
3,022 |
2,330 |
$0.00 |
| D0602 |
|
48 |
43 |
$0.00 |