| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,721 |
1,717 |
$56K |
| D0120 |
Periodic oral evaluation - established patient |
1,572 |
1,568 |
$36K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,740 |
1,736 |
$32K |
| D0220 |
Intraoral - periapical first radiographic image |
1,658 |
1,645 |
$19K |
| D0272 |
Bitewings - two radiographic images |
850 |
847 |
$18K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
611 |
576 |
$17K |
| D0274 |
Bitewings - four radiographic images |
499 |
498 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,519 |
1,514 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
81 |
69 |
$5K |
| D1351 |
Sealant - per tooth |
113 |
36 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
30 |
25 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
52 |
52 |
$2K |
| D0330 |
Panoramic radiographic image |
102 |
101 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
17 |
17 |
$518.89 |