| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,216 |
3,185 |
$102K |
| D0120 |
Periodic oral evaluation - established patient |
3,587 |
3,559 |
$76K |
| D1206 |
Topical application of fluoride varnish |
3,707 |
3,674 |
$67K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
950 |
402 |
$61K |
| D0272 |
Bitewings - two radiographic images |
1,466 |
1,455 |
$26K |
| D1110 |
Prophylaxis - adult |
654 |
653 |
$26K |
| D1351 |
Sealant - per tooth |
808 |
237 |
$21K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
375 |
348 |
$17K |
| D7140 |
Extraction, erupted tooth or exposed root |
128 |
75 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
356 |
351 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
284 |
283 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
95 |
70 |
$5K |
| D0274 |
Bitewings - four radiographic images |
78 |
78 |
$2K |