| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
873 |
870 |
$22K |
| D9920 |
|
368 |
352 |
$18K |
| D0120 |
Periodic oral evaluation - established patient |
1,251 |
1,246 |
$17K |
| D1206 |
Topical application of fluoride varnish |
1,207 |
1,203 |
$16K |
| D1110 |
Prophylaxis - adult |
401 |
399 |
$12K |
| D9630 |
|
618 |
612 |
$7K |
| D1351 |
Sealant - per tooth |
158 |
57 |
$4K |
| D0274 |
Bitewings - four radiographic images |
221 |
217 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
52 |
38 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
127 |
117 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
28 |
24 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
41 |
41 |
$1K |
| D0272 |
Bitewings - two radiographic images |
39 |
39 |
$1K |
| D1354 |
|
59 |
13 |
$0.00 |