| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,278 |
3,256 |
$109K |
| D0120 |
Periodic oral evaluation - established patient |
4,232 |
4,206 |
$99K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
488 |
249 |
$63K |
| D1110 |
Prophylaxis - adult |
1,162 |
1,156 |
$48K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,152 |
3,138 |
$40K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
923 |
871 |
$29K |
| D0272 |
Bitewings - two radiographic images |
1,182 |
1,174 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
1,918 |
1,904 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,709 |
1,700 |
$21K |
| D1206 |
Topical application of fluoride varnish |
527 |
527 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
123 |
123 |
$5K |
| D0350 |
|
112 |
79 |
$4K |
| D0274 |
Bitewings - four radiographic images |
40 |
40 |
$1K |