| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,730 |
2,654 |
$115K |
| D1206 |
Topical application of fluoride varnish |
4,434 |
4,343 |
$92K |
| D0120 |
Periodic oral evaluation - established patient |
3,543 |
3,465 |
$85K |
| D1120 |
Prophylaxis - child |
2,089 |
2,059 |
$70K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
987 |
497 |
$58K |
| D0330 |
Panoramic radiographic image |
1,218 |
1,167 |
$51K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
637 |
350 |
$44K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
899 |
878 |
$26K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
904 |
837 |
$25K |
| D0274 |
Bitewings - four radiographic images |
706 |
697 |
$18K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
132 |
49 |
$17K |
| D0272 |
Bitewings - two radiographic images |
548 |
545 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
141 |
135 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
24 |
24 |
$294.63 |