| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,845 |
3,589 |
$92K |
| D1120 |
Prophylaxis - child |
3,625 |
3,349 |
$89K |
| D1206 |
Topical application of fluoride varnish |
4,783 |
4,388 |
$71K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,450 |
1,200 |
$58K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
667 |
334 |
$57K |
| D1110 |
Prophylaxis - adult |
498 |
465 |
$18K |
| D0272 |
Bitewings - two radiographic images |
959 |
865 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
74 |
37 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
283 |
259 |
$4K |
| D0330 |
Panoramic radiographic image |
72 |
68 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
87 |
80 |
$4K |
| D1351 |
Sealant - per tooth |
242 |
59 |
$3K |
| D0274 |
Bitewings - four radiographic images |
38 |
37 |
$1K |