| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
817 |
813 |
$30K |
| D0120 |
Periodic oral evaluation - established patient |
880 |
872 |
$20K |
| D1206 |
Topical application of fluoride varnish |
536 |
534 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
397 |
395 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
359 |
357 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
355 |
353 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
41 |
16 |
$3K |
| D0272 |
Bitewings - two radiographic images |
150 |
149 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
121 |
114 |
$2K |
| D0274 |
Bitewings - four radiographic images |
64 |
64 |
$1K |
| D1351 |
Sealant - per tooth |
32 |
12 |
$1K |
| D1110 |
Prophylaxis - adult |
28 |
28 |
$1K |