| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,299 |
1,252 |
$39K |
| D0120 |
Periodic oral evaluation - established patient |
1,768 |
1,709 |
$38K |
| D1110 |
Prophylaxis - adult |
818 |
798 |
$37K |
| D1206 |
Topical application of fluoride varnish |
2,078 |
2,012 |
$36K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
315 |
164 |
$33K |
| D0274 |
Bitewings - four radiographic images |
711 |
691 |
$22K |
| D0330 |
Panoramic radiographic image |
293 |
285 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
81 |
50 |
$5K |
| D1351 |
Sealant - per tooth |
196 |
51 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
139 |
122 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
105 |
105 |
$3K |
| D0272 |
Bitewings - two radiographic images |
171 |
162 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
41 |
41 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
12 |
12 |
$167.64 |