| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,788 |
3,780 |
$166K |
| D1206 |
Topical application of fluoride varnish |
4,083 |
4,076 |
$126K |
| D1351 |
Sealant - per tooth |
5,120 |
1,410 |
$99K |
| D0120 |
Periodic oral evaluation - established patient |
3,564 |
3,558 |
$88K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,058 |
582 |
$74K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,486 |
1,412 |
$36K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
490 |
327 |
$27K |
| D0272 |
Bitewings - two radiographic images |
1,478 |
1,477 |
$15K |
| D0603 |
|
1,490 |
1,486 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
2,407 |
2,402 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,200 |
2,188 |
$10K |
| D1353 |
|
928 |
247 |
$9K |
| D0274 |
Bitewings - four radiographic images |
656 |
653 |
$8K |
| D9920 |
|
276 |
263 |
$7K |
| D1110 |
Prophylaxis - adult |
164 |
164 |
$7K |
| D0602 |
|
599 |
599 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
70 |
70 |
$2K |
| D0601 |
|
113 |
113 |
$1K |