| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
6,659 |
6,419 |
$276K |
| D1351 |
Sealant - per tooth |
2,462 |
1,494 |
$209K |
| D1206 |
Topical application of fluoride varnish |
6,268 |
6,050 |
$165K |
| D0120 |
Periodic oral evaluation - established patient |
5,164 |
4,995 |
$147K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,270 |
926 |
$141K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
586 |
477 |
$97K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,766 |
1,584 |
$87K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,544 |
1,469 |
$36K |
| D0274 |
Bitewings - four radiographic images |
1,828 |
1,735 |
$32K |
| D0272 |
Bitewings - two radiographic images |
1,540 |
1,481 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
355 |
351 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
536 |
521 |
$3K |