| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,899 |
3,899 |
$89K |
| D1110 |
Prophylaxis - adult |
1,722 |
1,722 |
$86K |
| D1120 |
Prophylaxis - child |
2,077 |
2,077 |
$72K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,748 |
3,748 |
$60K |
| D0272 |
Bitewings - two radiographic images |
2,538 |
2,538 |
$48K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
738 |
664 |
$24K |
| D0274 |
Bitewings - four radiographic images |
640 |
640 |
$17K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
173 |
152 |
$17K |
| D1351 |
Sealant - per tooth |
456 |
131 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
314 |
312 |
$12K |
| D0330 |
Panoramic radiographic image |
82 |
82 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
31 |
26 |
$2K |