| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,136 |
2,113 |
$71K |
| D1206 |
Topical application of fluoride varnish |
2,297 |
2,273 |
$47K |
| D0120 |
Periodic oral evaluation - established patient |
1,701 |
1,683 |
$34K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
568 |
566 |
$17K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
464 |
427 |
$15K |
| D0272 |
Bitewings - two radiographic images |
611 |
604 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
148 |
101 |
$12K |
| D9994 |
|
938 |
932 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
356 |
349 |
$4K |
| D1351 |
Sealant - per tooth |
59 |
15 |
$2K |
| D1110 |
Prophylaxis - adult |
40 |
40 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
163 |
157 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
19 |
14 |
$1K |
| D0240 |
|
85 |
51 |
$1K |