| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,515 |
1,494 |
$53K |
| D0120 |
Periodic oral evaluation - established patient |
1,770 |
1,745 |
$50K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,624 |
1,323 |
$29K |
| D1206 |
Topical application of fluoride varnish |
1,850 |
1,827 |
$26K |
| D1351 |
Sealant - per tooth |
665 |
111 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
1,437 |
1,413 |
$18K |
| D0272 |
Bitewings - two radiographic images |
661 |
657 |
$15K |
| D0274 |
Bitewings - four radiographic images |
352 |
344 |
$12K |
| D0145 |
Oral evaluation for a patient under three years of age |
66 |
66 |
$9K |
| D1110 |
Prophylaxis - adult |
169 |
166 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
19 |
13 |
$2K |
| D9248 |
|
16 |
12 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
35 |
35 |
$1K |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$765.36 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
13 |
12 |
$352.43 |
| D0603 |
|
1,156 |
1,149 |
$0.00 |
| D0602 |
|
1,000 |
995 |
$0.00 |