| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,425 |
2,397 |
$88K |
| D0120 |
Periodic oral evaluation - established patient |
1,603 |
1,581 |
$43K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,449 |
2,419 |
$43K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
524 |
516 |
$14K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
107 |
73 |
$7K |
| D0272 |
Bitewings - two radiographic images |
505 |
504 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
107 |
99 |
$2K |
| D1351 |
Sealant - per tooth |
89 |
12 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
194 |
192 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
90 |
73 |
$313.50 |