| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
311 |
235 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
466 |
347 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
448 |
323 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
185 |
114 |
$4K |
| D0272 |
Bitewings - two radiographic images |
216 |
157 |
$4K |
| D1110 |
Prophylaxis - adult |
125 |
86 |
$3K |
| D1351 |
Sealant - per tooth |
85 |
16 |
$2K |
| D0330 |
Panoramic radiographic image |
34 |
32 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
45 |
24 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
33 |
16 |
$906.67 |
| D1206 |
Topical application of fluoride varnish |
33 |
33 |
$679.44 |
| D0140 |
Limited oral evaluation - problem focused |
16 |
12 |
$437.56 |