| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,265 |
1,259 |
$67K |
| D0120 |
Periodic oral evaluation - established patient |
2,293 |
2,281 |
$65K |
| D1120 |
Prophylaxis - child |
1,554 |
1,546 |
$55K |
| D1206 |
Topical application of fluoride varnish |
2,500 |
2,490 |
$36K |
| D0274 |
Bitewings - four radiographic images |
1,054 |
1,046 |
$35K |
| D1351 |
Sealant - per tooth |
1,010 |
249 |
$28K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
646 |
613 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
218 |
170 |
$16K |
| D0272 |
Bitewings - two radiographic images |
629 |
625 |
$14K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
118 |
84 |
$10K |
| D0330 |
Panoramic radiographic image |
168 |
168 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
107 |
107 |
$2K |
| D0602 |
|
1,671 |
1,664 |
$0.00 |
| D0603 |
|
1,204 |
1,193 |
$0.00 |