| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1206 |
Topical application of fluoride varnish |
1,494 |
1,483 |
$26K |
| D0120 |
Periodic oral evaluation - established patient |
1,171 |
1,160 |
$25K |
| D0274 |
Bitewings - four radiographic images |
863 |
857 |
$25K |
| D1120 |
Prophylaxis - child |
815 |
811 |
$24K |
| D1351 |
Sealant - per tooth |
950 |
178 |
$24K |
| D1110 |
Prophylaxis - adult |
305 |
303 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
122 |
47 |
$6K |
| D0330 |
Panoramic radiographic image |
43 |
43 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
47 |
46 |
$834.75 |
| D0220 |
Intraoral - periapical first radiographic image |
47 |
40 |
$497.28 |
| D1999 |
|
358 |
300 |
$0.00 |