| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,005 |
1,988 |
$78K |
| D0120 |
Periodic oral evaluation - established patient |
2,168 |
2,150 |
$59K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,045 |
1,029 |
$19K |
| D1206 |
Topical application of fluoride varnish |
1,029 |
1,029 |
$19K |
| D0272 |
Bitewings - two radiographic images |
1,007 |
996 |
$19K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
148 |
73 |
$10K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
283 |
273 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
74 |
74 |
$3K |
| D0330 |
Panoramic radiographic image |
51 |
51 |
$2K |
| D0603 |
|
188 |
177 |
$2K |
| D1351 |
Sealant - per tooth |
41 |
14 |
$1K |
| D0240 |
|
24 |
24 |
$384.00 |
| D0601 |
|
37 |
37 |
$286.00 |