| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,717 |
1,673 |
$76K |
| D0120 |
Periodic oral evaluation - established patient |
2,036 |
1,993 |
$61K |
| D1206 |
Topical application of fluoride varnish |
2,350 |
2,295 |
$51K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
396 |
252 |
$39K |
| D1110 |
Prophylaxis - adult |
575 |
566 |
$34K |
| D0272 |
Bitewings - two radiographic images |
1,139 |
1,119 |
$33K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
917 |
854 |
$28K |
| D1354 |
|
592 |
135 |
$14K |
| D1351 |
Sealant - per tooth |
446 |
114 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
53 |
37 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
37 |
27 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
89 |
88 |
$2K |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$998.88 |