| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,457 |
1,451 |
$61K |
| D0120 |
Periodic oral evaluation - established patient |
1,363 |
1,360 |
$39K |
| D1206 |
Topical application of fluoride varnish |
1,429 |
1,423 |
$38K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
583 |
434 |
$36K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
334 |
325 |
$22K |
| D7140 |
Extraction, erupted tooth or exposed root |
274 |
228 |
$19K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
355 |
302 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
506 |
501 |
$13K |
| D0274 |
Bitewings - four radiographic images |
642 |
639 |
$11K |
| D1110 |
Prophylaxis - adult |
183 |
183 |
$9K |
| D1351 |
Sealant - per tooth |
112 |
49 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
319 |
313 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
931 |
910 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
834 |
653 |
$4K |
| D4341 |
|
29 |
14 |
$4K |
| D0330 |
Panoramic radiographic image |
153 |
152 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
141 |
141 |
$3K |
| D0272 |
Bitewings - two radiographic images |
268 |
265 |
$3K |
| D0270 |
|
18 |
17 |
$95.20 |