| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,478 |
2,967 |
$150K |
| D0120 |
Periodic oral evaluation - established patient |
2,837 |
2,742 |
$69K |
| D1110 |
Prophylaxis - adult |
1,722 |
1,662 |
$65K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,310 |
1,271 |
$22K |
| D1120 |
Prophylaxis - child |
603 |
597 |
$17K |
| D7140 |
Extraction, erupted tooth or exposed root |
155 |
87 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
93 |
65 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
62 |
45 |
$5K |
| D0272 |
Bitewings - two radiographic images |
254 |
249 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
309 |
275 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
199 |
82 |
$2K |
| D1206 |
Topical application of fluoride varnish |
14 |
14 |
$234.92 |