| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
950 |
903 |
$25K |
| D0120 |
Periodic oral evaluation - established patient |
1,315 |
1,249 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,475 |
1,393 |
$20K |
| D1110 |
Prophylaxis - adult |
509 |
477 |
$16K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
170 |
111 |
$15K |
| D7140 |
Extraction, erupted tooth or exposed root |
194 |
92 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
148 |
91 |
$10K |
| D0272 |
Bitewings - two radiographic images |
613 |
587 |
$10K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
494 |
470 |
$9K |
| D0330 |
Panoramic radiographic image |
151 |
146 |
$7K |
| D0274 |
Bitewings - four radiographic images |
279 |
265 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
169 |
158 |
$2K |
| D2394 |
|
13 |
12 |
$2K |
| D1351 |
Sealant - per tooth |
58 |
29 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
45 |
39 |
$844.00 |