| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
828 |
828 |
$37K |
| D1120 |
Prophylaxis - child |
811 |
811 |
$36K |
| D0272 |
Bitewings - two radiographic images |
630 |
630 |
$21K |
| D1351 |
Sealant - per tooth |
363 |
138 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
587 |
587 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
711 |
705 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
675 |
673 |
$11K |
| D1206 |
Topical application of fluoride varnish |
225 |
225 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
62 |
29 |
$7K |
| D9920 |
|
98 |
88 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
202 |
184 |
$5K |
| D0603 |
|
283 |
283 |
$3K |