| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,139 |
2,084 |
$58K |
| D0120 |
Periodic oral evaluation - established patient |
1,692 |
1,656 |
$45K |
| D1206 |
Topical application of fluoride varnish |
2,290 |
2,229 |
$37K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
476 |
456 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
1,003 |
971 |
$15K |
| D0272 |
Bitewings - two radiographic images |
916 |
887 |
$15K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
129 |
82 |
$15K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
295 |
277 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,002 |
834 |
$12K |
| D0330 |
Panoramic radiographic image |
97 |
94 |
$5K |
| D1351 |
Sealant - per tooth |
126 |
50 |
$4K |
| D1110 |
Prophylaxis - adult |
33 |
29 |
$1K |