| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
5,603 |
4,561 |
$143K |
| D0120 |
Periodic oral evaluation - established patient |
4,835 |
3,930 |
$109K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,927 |
4,782 |
$84K |
| D0272 |
Bitewings - two radiographic images |
2,161 |
1,782 |
$39K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,143 |
873 |
$32K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
118 |
36 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
565 |
441 |
$6K |
| D0330 |
Panoramic radiographic image |
106 |
99 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
22 |
15 |
$2K |
| D0274 |
Bitewings - four radiographic images |
16 |
12 |
$416.07 |
| D0220 |
Intraoral - periapical first radiographic image |
12 |
12 |
$205.58 |