| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,983 |
1,935 |
$53K |
| D1206 |
Topical application of fluoride varnish |
2,737 |
2,675 |
$46K |
| D0120 |
Periodic oral evaluation - established patient |
2,358 |
2,302 |
$45K |
| D1110 |
Prophylaxis - adult |
858 |
847 |
$33K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
192 |
136 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
500 |
497 |
$14K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
333 |
314 |
$12K |
| D0272 |
Bitewings - two radiographic images |
479 |
466 |
$8K |
| D0274 |
Bitewings - four radiographic images |
186 |
186 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
218 |
212 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
17 |
13 |
$1K |
| D0330 |
Panoramic radiographic image |
30 |
29 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
20 |
12 |
$1K |