| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,741 |
2,395 |
$65K |
| D1120 |
Prophylaxis - child |
1,699 |
1,479 |
$63K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,833 |
2,474 |
$55K |
| D1110 |
Prophylaxis - adult |
672 |
594 |
$37K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
857 |
647 |
$31K |
| D0274 |
Bitewings - four radiographic images |
559 |
506 |
$19K |
| D1351 |
Sealant - per tooth |
603 |
104 |
$13K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
43 |
24 |
$4K |
| D0330 |
Panoramic radiographic image |
42 |
38 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
29 |
29 |
$1K |