| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,277 |
3,195 |
$62K |
| D1206 |
Topical application of fluoride varnish |
3,657 |
3,570 |
$58K |
| D1120 |
Prophylaxis - child |
2,081 |
2,038 |
$57K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,534 |
1,481 |
$53K |
| D1110 |
Prophylaxis - adult |
1,422 |
1,389 |
$49K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
498 |
310 |
$26K |
| D0272 |
Bitewings - two radiographic images |
1,555 |
1,525 |
$26K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
245 |
172 |
$11K |
| D7111 |
|
124 |
77 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
76 |
57 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
26 |
26 |
$741.00 |