| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,510 |
1,374 |
$70K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
602 |
242 |
$37K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
967 |
686 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,599 |
1,459 |
$22K |
| D0120 |
Periodic oral evaluation - established patient |
1,046 |
955 |
$19K |
| D0272 |
Bitewings - two radiographic images |
968 |
888 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
256 |
69 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
152 |
135 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
250 |
218 |
$2K |
| D0330 |
Panoramic radiographic image |
13 |
13 |
$480.60 |