| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
5,060 |
5,014 |
$147K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,449 |
6,381 |
$115K |
| D0120 |
Periodic oral evaluation - established patient |
5,679 |
5,613 |
$97K |
| D1110 |
Prophylaxis - adult |
1,266 |
1,245 |
$50K |
| D1351 |
Sealant - per tooth |
1,709 |
715 |
$49K |
| D0272 |
Bitewings - two radiographic images |
2,211 |
2,196 |
$38K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,198 |
1,080 |
$36K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
202 |
114 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
451 |
451 |
$15K |
| D0330 |
Panoramic radiographic image |
224 |
224 |
$12K |
| D0274 |
Bitewings - four radiographic images |
304 |
294 |
$6K |
| D0240 |
|
167 |
90 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
16 |
12 |
$1K |