| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
16,397 |
15,706 |
$678K |
| D0120 |
Periodic oral evaluation - established patient |
15,893 |
15,170 |
$496K |
| D1208 |
Topical application of fluoride, excluding varnish |
16,123 |
15,406 |
$419K |
| D0272 |
Bitewings - two radiographic images |
4,151 |
3,976 |
$121K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
751 |
464 |
$74K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
767 |
410 |
$64K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
942 |
878 |
$45K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
186 |
180 |
$11K |
| D0330 |
Panoramic radiographic image |
161 |
126 |
$9K |
| D1351 |
Sealant - per tooth |
255 |
78 |
$9K |
| D1110 |
Prophylaxis - adult |
312 |
301 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
136 |
118 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
184 |
177 |
$3K |
| D0274 |
Bitewings - four radiographic images |
24 |
24 |
$1K |