| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,890 |
1,888 |
$62K |
| D1206 |
Topical application of fluoride varnish |
2,043 |
2,039 |
$42K |
| D0120 |
Periodic oral evaluation - established patient |
1,990 |
1,985 |
$39K |
| D1110 |
Prophylaxis - adult |
394 |
385 |
$18K |
| D9920 |
|
187 |
175 |
$13K |
| D9630 |
|
561 |
553 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
322 |
303 |
$9K |
| D0274 |
Bitewings - four radiographic images |
282 |
276 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
176 |
157 |
$6K |
| D1351 |
Sealant - per tooth |
157 |
44 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
42 |
26 |
$4K |
| D0272 |
Bitewings - two radiographic images |
153 |
152 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
22 |
16 |
$2K |
| D1354 |
|
100 |
40 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
14 |
13 |
$134.16 |