| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,206 |
1,085 |
$24K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
297 |
154 |
$19K |
| D1206 |
Topical application of fluoride varnish |
1,023 |
930 |
$18K |
| D1120 |
Prophylaxis - child |
613 |
543 |
$16K |
| D1351 |
Sealant - per tooth |
611 |
127 |
$13K |
| D1110 |
Prophylaxis - adult |
301 |
266 |
$11K |
| D0274 |
Bitewings - four radiographic images |
394 |
345 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
307 |
268 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
265 |
183 |
$5K |
| D0330 |
Panoramic radiographic image |
56 |
52 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
24 |
14 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
25 |
25 |
$0.00 |