| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,161 |
1,110 |
$46K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,164 |
1,113 |
$29K |
| D0120 |
Periodic oral evaluation - established patient |
1,019 |
970 |
$28K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
290 |
230 |
$14K |
| D1351 |
Sealant - per tooth |
298 |
160 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
306 |
246 |
$10K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
301 |
243 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
198 |
196 |
$4K |
| D0330 |
Panoramic radiographic image |
166 |
160 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
90 |
65 |
$4K |
| D0272 |
Bitewings - two radiographic images |
398 |
375 |
$4K |
| D0274 |
Bitewings - four radiographic images |
167 |
161 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
166 |
158 |
$912.80 |
| D9110 |
|
14 |
13 |
$715.00 |