| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
505 |
484 |
$11K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
296 |
289 |
$10K |
| D0120 |
Periodic oral evaluation - established patient |
554 |
534 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
159 |
126 |
$8K |
| D1206 |
Topical application of fluoride varnish |
630 |
602 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
117 |
85 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
129 |
127 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
50 |
41 |
$2K |
| D0272 |
Bitewings - two radiographic images |
110 |
105 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
43 |
43 |
$846.86 |
| D0220 |
Intraoral - periapical first radiographic image |
87 |
84 |
$596.20 |
| D0330 |
Panoramic radiographic image |
14 |
13 |
$364.05 |
| D0230 |
Intraoral - periapical each additional radiographic image |
30 |
29 |
$164.36 |