| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,850 |
2,766 |
$90K |
| D0120 |
Periodic oral evaluation - established patient |
3,431 |
3,337 |
$79K |
| D1206 |
Topical application of fluoride varnish |
3,681 |
3,581 |
$75K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,040 |
440 |
$73K |
| D1110 |
Prophylaxis - adult |
786 |
770 |
$33K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,130 |
1,033 |
$32K |
| D0272 |
Bitewings - two radiographic images |
1,157 |
1,134 |
$20K |
| D0274 |
Bitewings - four radiographic images |
150 |
149 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
92 |
91 |
$3K |
| D0330 |
Panoramic radiographic image |
29 |
29 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
79 |
77 |
$955.25 |
| D1351 |
Sealant - per tooth |
45 |
12 |
$917.52 |