| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,930 |
2,901 |
$139K |
| D0120 |
Periodic oral evaluation - established patient |
3,841 |
3,807 |
$104K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,534 |
2,520 |
$50K |
| D0272 |
Bitewings - two radiographic images |
2,266 |
2,248 |
$47K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,150 |
1,048 |
$41K |
| D1120 |
Prophylaxis - child |
1,159 |
1,158 |
$40K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
70 |
57 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
406 |
376 |
$5K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
42 |
28 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
71 |
69 |
$3K |
| D1351 |
Sealant - per tooth |
83 |
26 |
$2K |