| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,876 |
2,773 |
$116K |
| D0120 |
Periodic oral evaluation - established patient |
3,058 |
2,952 |
$30K |
| D1110 |
Prophylaxis - adult |
540 |
531 |
$21K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
319 |
147 |
$15K |
| D0330 |
Panoramic radiographic image |
105 |
99 |
$8K |
| D0274 |
Bitewings - four radiographic images |
2,745 |
2,653 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,335 |
3,228 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
2,834 |
2,685 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
164 |
162 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
39 |
39 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
96 |
79 |
$2K |
| D1351 |
Sealant - per tooth |
238 |
55 |
$512.96 |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,122 |
2,019 |
$468.37 |
| D0272 |
Bitewings - two radiographic images |
131 |
131 |
$78.00 |
| D1330 |
|
128 |
128 |
$0.00 |