| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,247 |
1,215 |
$35K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
289 |
156 |
$29K |
| D1110 |
Prophylaxis - adult |
457 |
450 |
$24K |
| D0274 |
Bitewings - four radiographic images |
601 |
591 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,284 |
1,252 |
$18K |
| D1120 |
Prophylaxis - child |
474 |
459 |
$17K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
346 |
325 |
$9K |
| D0272 |
Bitewings - two radiographic images |
248 |
240 |
$5K |
| D1351 |
Sealant - per tooth |
70 |
25 |
$2K |
| D0603 |
|
1,459 |
1,421 |
$0.00 |