| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,469 |
3,424 |
$119K |
| D0120 |
Periodic oral evaluation - established patient |
3,702 |
3,660 |
$98K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,883 |
3,835 |
$53K |
| D0272 |
Bitewings - two radiographic images |
1,956 |
1,925 |
$40K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
486 |
460 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
145 |
70 |
$12K |
| D1110 |
Prophylaxis - adult |
197 |
196 |
$9K |
| D1351 |
Sealant - per tooth |
287 |
86 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
74 |
73 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
187 |
182 |
$2K |
| D0330 |
Panoramic radiographic image |
69 |
68 |
$2K |
| D0274 |
Bitewings - four radiographic images |
12 |
12 |
$415.32 |
| D0602 |
|
2,233 |
2,195 |
$0.00 |
| D0603 |
|
2,484 |
2,451 |
$0.00 |