| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,574 |
1,503 |
$62K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,337 |
1,272 |
$33K |
| D0120 |
Periodic oral evaluation - established patient |
1,005 |
977 |
$27K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
284 |
244 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
683 |
642 |
$13K |
| D0272 |
Bitewings - two radiographic images |
705 |
680 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
246 |
209 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
956 |
902 |
$5K |
| D1351 |
Sealant - per tooth |
53 |
40 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
107 |
90 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
744 |
713 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
16 |
12 |
$585.00 |