| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
5,405 |
4,398 |
$123K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,157 |
538 |
$102K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,648 |
2,858 |
$101K |
| D0330 |
Panoramic radiographic image |
1,800 |
1,470 |
$77K |
| D0140 |
Limited oral evaluation - problem focused |
1,802 |
1,520 |
$63K |
| D0120 |
Periodic oral evaluation - established patient |
1,917 |
1,681 |
$45K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,776 |
2,379 |
$39K |
| D0210 |
Intraoral - complete series of radiographic images |
470 |
425 |
$28K |
| D7140 |
Extraction, erupted tooth or exposed root |
297 |
175 |
$21K |
| D1206 |
Topical application of fluoride varnish |
1,120 |
788 |
$18K |
| D0274 |
Bitewings - four radiographic images |
338 |
289 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
897 |
687 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
72 |
33 |
$5K |
| D0272 |
Bitewings - two radiographic images |
338 |
237 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
185 |
152 |
$2K |