| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
5,449 |
5,429 |
$181K |
| D0120 |
Periodic oral evaluation - established patient |
5,912 |
5,890 |
$143K |
| D1206 |
Topical application of fluoride varnish |
6,563 |
6,534 |
$128K |
| D0272 |
Bitewings - two radiographic images |
1,814 |
1,799 |
$38K |
| D1110 |
Prophylaxis - adult |
149 |
149 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
196 |
191 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
26 |
14 |
$4K |
| D1351 |
Sealant - per tooth |
71 |
25 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
20 |
12 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
36 |
36 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
63 |
63 |
$817.25 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
13 |
13 |
$522.92 |