| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,900 |
3,841 |
$108K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,533 |
4,471 |
$78K |
| D0120 |
Periodic oral evaluation - established patient |
3,945 |
3,891 |
$65K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
863 |
482 |
$56K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
694 |
425 |
$53K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,643 |
1,431 |
$46K |
| D0272 |
Bitewings - two radiographic images |
1,368 |
1,345 |
$23K |
| D1110 |
Prophylaxis - adult |
371 |
369 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
411 |
407 |
$12K |
| D1351 |
Sealant - per tooth |
330 |
122 |
$10K |
| D0274 |
Bitewings - four radiographic images |
157 |
155 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
388 |
366 |
$3K |
| D3120 |
|
58 |
40 |
$813.62 |
| D0230 |
Intraoral - periapical each additional radiographic image |
96 |
51 |
$801.45 |