| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,394 |
3,344 |
$86K |
| D1120 |
Prophylaxis - child |
2,129 |
2,106 |
$79K |
| D1110 |
Prophylaxis - adult |
607 |
592 |
$32K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,968 |
1,941 |
$30K |
| D0272 |
Bitewings - two radiographic images |
1,315 |
1,290 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
1,043 |
1,019 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
904 |
886 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
22 |
13 |
$3K |
| D1206 |
Topical application of fluoride varnish |
93 |
88 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
65 |
64 |
$2K |