| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,524 |
4,455 |
$146K |
| D0120 |
Periodic oral evaluation - established patient |
4,749 |
4,658 |
$112K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,268 |
4,172 |
$84K |
| D0272 |
Bitewings - two radiographic images |
1,496 |
1,479 |
$26K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
565 |
528 |
$16K |
| D1206 |
Topical application of fluoride varnish |
769 |
759 |
$16K |
| D1110 |
Prophylaxis - adult |
380 |
367 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
78 |
54 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
193 |
187 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
55 |
55 |
$2K |
| D0601 |
|
55 |
52 |
$0.00 |
| D0603 |
|
12 |
12 |
$0.00 |