| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,632 |
1,546 |
$59K |
| D0120 |
Periodic oral evaluation - established patient |
1,289 |
1,233 |
$30K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,458 |
1,395 |
$28K |
| D0272 |
Bitewings - two radiographic images |
550 |
529 |
$13K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
71 |
26 |
$10K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
253 |
233 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
384 |
338 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
171 |
163 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
292 |
151 |
$3K |
| D1206 |
Topical application of fluoride varnish |
140 |
131 |
$2K |
| D1354 |
|
39 |
18 |
$2K |
| D1351 |
Sealant - per tooth |
49 |
17 |
$2K |
| D0330 |
Panoramic radiographic image |
13 |
13 |
$737.00 |