| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,621 |
4,463 |
$141K |
| D0120 |
Periodic oral evaluation - established patient |
5,256 |
5,076 |
$139K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,265 |
6,039 |
$90K |
| D1110 |
Prophylaxis - adult |
1,518 |
1,466 |
$56K |
| D0272 |
Bitewings - two radiographic images |
2,248 |
2,172 |
$41K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
329 |
133 |
$17K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
480 |
455 |
$14K |
| D1351 |
Sealant - per tooth |
181 |
25 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
17 |
13 |
$1K |
| D1330 |
|
107 |
106 |
$520.00 |
| D0220 |
Intraoral - periapical first radiographic image |
37 |
37 |
$126.16 |
| D0603 |
|
31 |
31 |
$17.00 |