| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,913 |
3,880 |
$136K |
| D0120 |
Periodic oral evaluation - established patient |
4,988 |
4,930 |
$124K |
| D1206 |
Topical application of fluoride varnish |
4,973 |
4,916 |
$103K |
| D1110 |
Prophylaxis - adult |
1,192 |
1,169 |
$56K |
| D0272 |
Bitewings - two radiographic images |
1,805 |
1,790 |
$38K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
217 |
112 |
$29K |
| D1351 |
Sealant - per tooth |
334 |
96 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
235 |
234 |
$9K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
294 |
281 |
$9K |
| D0330 |
Panoramic radiographic image |
176 |
176 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
56 |
38 |
$6K |
| D0145 |
Oral evaluation for a patient under three years of age |
38 |
38 |
$1K |