| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,474 |
1,428 |
$39K |
| D1110 |
Prophylaxis - adult |
1,070 |
1,051 |
$38K |
| D0120 |
Periodic oral evaluation - established patient |
1,935 |
1,903 |
$36K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
476 |
270 |
$32K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,548 |
1,510 |
$22K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
195 |
108 |
$15K |
| D0330 |
Panoramic radiographic image |
334 |
324 |
$14K |
| D0272 |
Bitewings - two radiographic images |
599 |
581 |
$10K |
| D1999 |
|
532 |
461 |
$9K |
| D0274 |
Bitewings - four radiographic images |
400 |
390 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
473 |
452 |
$9K |
| D1206 |
Topical application of fluoride varnish |
438 |
429 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
340 |
273 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
21 |
12 |
$1K |
| D1351 |
Sealant - per tooth |
44 |
12 |
$832.00 |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$360.00 |