| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,710 |
2,691 |
$70K |
| D1206 |
Topical application of fluoride varnish |
3,313 |
3,285 |
$63K |
| D0120 |
Periodic oral evaluation - established patient |
2,691 |
2,664 |
$56K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
555 |
243 |
$33K |
| D1351 |
Sealant - per tooth |
782 |
157 |
$20K |
| D1110 |
Prophylaxis - adult |
499 |
491 |
$20K |
| D0272 |
Bitewings - two radiographic images |
1,013 |
1,008 |
$17K |
| D0603 |
|
1,304 |
1,284 |
$13K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
275 |
267 |
$10K |
| D1330 |
|
1,946 |
1,926 |
$9K |
| D0330 |
Panoramic radiographic image |
132 |
129 |
$5K |
| D0145 |
Oral evaluation for a patient under three years of age |
233 |
233 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
94 |
64 |
$5K |
| D0602 |
|
376 |
376 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
378 |
366 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
127 |
125 |
$3K |
| D0601 |
|
208 |
208 |
$2K |
| D9110 |
|
60 |
60 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
186 |
179 |
$2K |
| D9248 |
|
12 |
12 |
$1K |
| D0274 |
Bitewings - four radiographic images |
39 |
39 |
$1K |
| D1310 |
|
773 |
754 |
$16.00 |