| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
5,501 |
5,494 |
$256K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,544 |
1,421 |
$228K |
| D0120 |
Periodic oral evaluation - established patient |
6,488 |
6,479 |
$205K |
| D1206 |
Topical application of fluoride varnish |
4,965 |
4,957 |
$140K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,249 |
753 |
$114K |
| D1110 |
Prophylaxis - adult |
1,635 |
1,633 |
$99K |
| D0272 |
Bitewings - two radiographic images |
2,946 |
2,941 |
$73K |
| D1351 |
Sealant - per tooth |
1,241 |
296 |
$48K |
| D0330 |
Panoramic radiographic image |
503 |
502 |
$28K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
311 |
236 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
541 |
541 |
$19K |
| D7140 |
Extraction, erupted tooth or exposed root |
226 |
114 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
585 |
585 |
$10K |
| D0274 |
Bitewings - four radiographic images |
141 |
141 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
355 |
348 |
$5K |
| D1330 |
|
3,778 |
3,777 |
$0.00 |