| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,079 |
3,746 |
$157K |
| D0120 |
Periodic oral evaluation - established patient |
4,038 |
3,708 |
$106K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,990 |
2,763 |
$74K |
| D1351 |
Sealant - per tooth |
623 |
427 |
$37K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
338 |
252 |
$23K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
629 |
542 |
$15K |
| D0272 |
Bitewings - two radiographic images |
1,548 |
1,436 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
765 |
670 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
1,217 |
1,083 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
83 |
65 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
14 |
13 |
$210.60 |