| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,732 |
3,491 |
$150K |
| D0120 |
Periodic oral evaluation - established patient |
3,714 |
3,473 |
$102K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,418 |
2,219 |
$62K |
| D1351 |
Sealant - per tooth |
839 |
400 |
$60K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
737 |
562 |
$58K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
972 |
822 |
$27K |
| D9110 |
|
495 |
460 |
$27K |
| D0272 |
Bitewings - two radiographic images |
900 |
837 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
539 |
486 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
52 |
26 |
$3K |
| D2332 |
|
18 |
12 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
353 |
325 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
22 |
17 |
$987.20 |