| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,199 |
1,182 |
$37K |
| D0120 |
Periodic oral evaluation - established patient |
1,501 |
1,475 |
$34K |
| D1206 |
Topical application of fluoride varnish |
1,755 |
1,723 |
$31K |
| D1110 |
Prophylaxis - adult |
451 |
441 |
$21K |
| D0272 |
Bitewings - two radiographic images |
569 |
558 |
$12K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
216 |
208 |
$7K |
| D1351 |
Sealant - per tooth |
181 |
47 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
41 |
30 |
$6K |
| D0330 |
Panoramic radiographic image |
82 |
82 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
21 |
13 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
36 |
36 |
$1K |
| D0274 |
Bitewings - four radiographic images |
37 |
37 |
$1K |