| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,168 |
3,044 |
$104K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
929 |
450 |
$89K |
| D0120 |
Periodic oral evaluation - established patient |
3,012 |
2,920 |
$87K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,673 |
3,514 |
$56K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
462 |
274 |
$36K |
| D0272 |
Bitewings - two radiographic images |
1,272 |
1,221 |
$27K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
789 |
712 |
$24K |
| D1110 |
Prophylaxis - adult |
532 |
506 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
347 |
327 |
$19K |
| D1351 |
Sealant - per tooth |
649 |
221 |
$14K |
| D0330 |
Panoramic radiographic image |
194 |
185 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
44 |
41 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
176 |
169 |
$1K |