| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
5,511 |
4,860 |
$124K |
| D1120 |
Prophylaxis - child |
2,637 |
2,343 |
$60K |
| D1206 |
Topical application of fluoride varnish |
2,985 |
2,544 |
$39K |
| D1110 |
Prophylaxis - adult |
505 |
456 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
669 |
642 |
$10K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
193 |
162 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
62 |
29 |
$6K |
| D0272 |
Bitewings - two radiographic images |
221 |
192 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
36 |
13 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
27 |
12 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
28 |
26 |
$933.12 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12 |
12 |
$466.51 |