| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1206 |
Topical application of fluoride varnish |
1,038 |
1,017 |
$47K |
| D1120 |
Prophylaxis - child |
775 |
764 |
$46K |
| D0120 |
Periodic oral evaluation - established patient |
893 |
876 |
$44K |
| D0272 |
Bitewings - two radiographic images |
491 |
482 |
$21K |
| D0274 |
Bitewings - four radiographic images |
327 |
321 |
$19K |
| D1110 |
Prophylaxis - adult |
186 |
180 |
$16K |
| D1351 |
Sealant - per tooth |
234 |
80 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
29 |
24 |
$7K |
| D0330 |
Panoramic radiographic image |
56 |
56 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
46 |
46 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
30 |
25 |
$2K |