| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,809 |
2,797 |
$101K |
| D0120 |
Periodic oral evaluation - established patient |
3,628 |
3,615 |
$91K |
| D1206 |
Topical application of fluoride varnish |
3,711 |
3,693 |
$63K |
| D1110 |
Prophylaxis - adult |
816 |
813 |
$33K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,042 |
948 |
$25K |
| D0272 |
Bitewings - two radiographic images |
1,119 |
1,110 |
$17K |
| D0603 |
|
903 |
900 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
154 |
78 |
$7K |
| D0274 |
Bitewings - four radiographic images |
255 |
255 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
97 |
57 |
$6K |
| D1330 |
|
570 |
570 |
$5K |
| D0330 |
Panoramic radiographic image |
145 |
144 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
25 |
12 |
$2K |
| D0601 |
|
168 |
168 |
$2K |
| D1351 |
Sealant - per tooth |
36 |
14 |
$910.00 |
| D0220 |
Intraoral - periapical first radiographic image |
41 |
41 |
$475.76 |
| D0210 |
Intraoral - complete series of radiographic images |
14 |
14 |
$464.00 |