| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
640 |
586 |
$23K |
| D0120 |
Periodic oral evaluation - established patient |
536 |
492 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
539 |
487 |
$13K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
344 |
304 |
$9K |
| D1351 |
Sealant - per tooth |
110 |
41 |
$7K |
| D0274 |
Bitewings - four radiographic images |
159 |
148 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
294 |
256 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
250 |
218 |
$839.80 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
15 |
13 |
$770.40 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
38 |
36 |
$694.65 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
17 |
12 |
$586.15 |
| D1206 |
Topical application of fluoride varnish |
25 |
25 |
$546.00 |
| D0140 |
Limited oral evaluation - problem focused |
16 |
14 |
$243.00 |