| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
324 |
318 |
$12K |
| D1206 |
Topical application of fluoride varnish |
425 |
419 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
187 |
182 |
$10K |
| D0120 |
Periodic oral evaluation - established patient |
355 |
348 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
86 |
43 |
$9K |
| D1110 |
Prophylaxis - adult |
159 |
156 |
$8K |
| D0274 |
Bitewings - four radiographic images |
259 |
253 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
530 |
509 |
$7K |
| D0330 |
Panoramic radiographic image |
146 |
141 |
$7K |
| D1351 |
Sealant - per tooth |
198 |
53 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
525 |
458 |
$5K |
| D0272 |
Bitewings - two radiographic images |
175 |
172 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
39 |
34 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
34 |
31 |
$1K |
| D0240 |
|
36 |
17 |
$784.32 |