| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,746 |
2,682 |
$82K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
909 |
361 |
$75K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,017 |
2,939 |
$68K |
| D0120 |
Periodic oral evaluation - established patient |
2,558 |
2,489 |
$66K |
| D7140 |
Extraction, erupted tooth or exposed root |
644 |
232 |
$63K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
653 |
619 |
$30K |
| D1351 |
Sealant - per tooth |
836 |
263 |
$27K |
| D0272 |
Bitewings - two radiographic images |
1,094 |
1,069 |
$17K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
142 |
53 |
$16K |
| D0330 |
Panoramic radiographic image |
172 |
167 |
$12K |
| D2335 |
|
59 |
25 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
248 |
244 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
111 |
68 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
520 |
511 |
$4K |
| D1110 |
Prophylaxis - adult |
65 |
65 |
$3K |
| D0274 |
Bitewings - four radiographic images |
91 |
91 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
56 |
56 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
232 |
80 |
$2K |