| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
288 |
281 |
$8K |
| D1120 |
Prophylaxis - child |
174 |
172 |
$6K |
| D1110 |
Prophylaxis - adult |
80 |
78 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
284 |
278 |
$4K |
| D0272 |
Bitewings - two radiographic images |
119 |
118 |
$3K |
| D0274 |
Bitewings - four radiographic images |
76 |
74 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
218 |
206 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
23 |
15 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
195 |
179 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
68 |
62 |
$2K |
| D1351 |
Sealant - per tooth |
38 |
14 |
$1K |
| D0603 |
|
202 |
199 |
$0.00 |
| D0602 |
|
12 |
12 |
$0.00 |
| D0601 |
|
34 |
32 |
$0.00 |