| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,705 |
1,661 |
$55K |
| D1206 |
Topical application of fluoride varnish |
2,546 |
2,481 |
$51K |
| D0120 |
Periodic oral evaluation - established patient |
2,122 |
2,066 |
$49K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
828 |
645 |
$23K |
| D1110 |
Prophylaxis - adult |
492 |
480 |
$20K |
| D0272 |
Bitewings - two radiographic images |
1,033 |
1,003 |
$17K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
170 |
91 |
$12K |
| D0330 |
Panoramic radiographic image |
76 |
71 |
$3K |
| D1351 |
Sealant - per tooth |
87 |
40 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
76 |
74 |
$2K |