| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1208 |
Topical application of fluoride, excluding varnish |
1,213 |
1,039 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
1,159 |
989 |
$11K |
| D1110 |
Prophylaxis - adult |
524 |
454 |
$10K |
| D1120 |
Prophylaxis - child |
699 |
601 |
$10K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
429 |
360 |
$5K |
| D0272 |
Bitewings - two radiographic images |
534 |
475 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
170 |
90 |
$4K |
| D0330 |
Panoramic radiographic image |
49 |
35 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
159 |
142 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
60 |
26 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
51 |
20 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
121 |
108 |
$666.48 |