| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,134 |
4,109 |
$138K |
| D0120 |
Periodic oral evaluation - established patient |
4,982 |
4,945 |
$117K |
| D1206 |
Topical application of fluoride varnish |
5,067 |
5,034 |
$99K |
| D1110 |
Prophylaxis - adult |
909 |
900 |
$36K |
| D0272 |
Bitewings - two radiographic images |
1,658 |
1,643 |
$35K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
628 |
596 |
$9K |
| D0274 |
Bitewings - four radiographic images |
304 |
296 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
57 |
25 |
$6K |
| D0330 |
Panoramic radiographic image |
117 |
117 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
47 |
24 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
184 |
180 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
34 |
34 |
$1K |
| D1351 |
Sealant - per tooth |
44 |
12 |
$1K |
| D0240 |
|
28 |
14 |
$392.80 |