| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,808 |
1,799 |
$19K |
| D1206 |
Topical application of fluoride varnish |
2,054 |
2,044 |
$13K |
| D0120 |
Periodic oral evaluation - established patient |
1,889 |
1,880 |
$12K |
| D0272 |
Bitewings - two radiographic images |
524 |
520 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
394 |
384 |
$3K |
| D1110 |
Prophylaxis - adult |
182 |
182 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
899 |
429 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
123 |
118 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
612 |
608 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
176 |
114 |
$2K |
| D1351 |
Sealant - per tooth |
174 |
63 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
80 |
80 |
$1K |
| D0240 |
|
86 |
44 |
$0.00 |
| D9310 |
|
13 |
13 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
66 |
38 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
43 |
43 |
$0.00 |