| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,692 |
2,651 |
$71K |
| D1120 |
Prophylaxis - child |
1,561 |
1,542 |
$66K |
| D1110 |
Prophylaxis - adult |
1,531 |
1,477 |
$56K |
| D1206 |
Topical application of fluoride varnish |
2,395 |
2,348 |
$51K |
| D0272 |
Bitewings - two radiographic images |
690 |
678 |
$18K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
183 |
114 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
112 |
83 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
564 |
494 |
$5K |
| D0274 |
Bitewings - four radiographic images |
166 |
157 |
$5K |
| D1351 |
Sealant - per tooth |
118 |
42 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
28 |
28 |
$811.38 |
| D0330 |
Panoramic radiographic image |
20 |
18 |
$456.90 |