| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,743 |
3,248 |
$84K |
| D1110 |
Prophylaxis - adult |
1,572 |
1,375 |
$53K |
| D1120 |
Prophylaxis - child |
1,626 |
1,413 |
$38K |
| D1206 |
Topical application of fluoride varnish |
2,515 |
2,206 |
$36K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
196 |
78 |
$16K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
474 |
319 |
$15K |
| D0272 |
Bitewings - two radiographic images |
471 |
397 |
$7K |
| D0274 |
Bitewings - four radiographic images |
252 |
197 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
157 |
55 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
216 |
175 |
$3K |
| D1351 |
Sealant - per tooth |
54 |
26 |
$2K |
| D0330 |
Panoramic radiographic image |
21 |
12 |
$619.50 |
| D0230 |
Intraoral - periapical each additional radiographic image |
60 |
30 |
$490.28 |