| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
8,244 |
8,069 |
$352K |
| D0120 |
Periodic oral evaluation - established patient |
8,570 |
8,396 |
$248K |
| D1206 |
Topical application of fluoride varnish |
9,865 |
9,668 |
$241K |
| D0272 |
Bitewings - two radiographic images |
1,944 |
1,889 |
$29K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
191 |
119 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
374 |
367 |
$19K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
980 |
912 |
$18K |
| D1351 |
Sealant - per tooth |
283 |
57 |
$9K |
| D1330 |
|
1,391 |
1,347 |
$9K |
| D1110 |
Prophylaxis - adult |
140 |
140 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
110 |
108 |
$5K |
| D0330 |
Panoramic radiographic image |
93 |
91 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
17 |
12 |
$2K |