| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
887 |
849 |
$38K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
512 |
490 |
$31K |
| D1206 |
Topical application of fluoride varnish |
866 |
830 |
$23K |
| D0120 |
Periodic oral evaluation - established patient |
357 |
343 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
107 |
41 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
127 |
122 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
78 |
70 |
$4K |
| D0272 |
Bitewings - two radiographic images |
149 |
141 |
$4K |
| D1351 |
Sealant - per tooth |
60 |
15 |
$2K |
| D0330 |
Panoramic radiographic image |
19 |
19 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
64 |
61 |
$1K |