| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
914 |
890 |
$30K |
| D0120 |
Periodic oral evaluation - established patient |
1,153 |
1,119 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,083 |
1,054 |
$21K |
| D0274 |
Bitewings - four radiographic images |
729 |
702 |
$19K |
| D1110 |
Prophylaxis - adult |
455 |
431 |
$18K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
195 |
136 |
$13K |
| D0330 |
Panoramic radiographic image |
306 |
299 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
155 |
122 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
199 |
190 |
$5K |
| D0272 |
Bitewings - two radiographic images |
276 |
268 |
$5K |
| D1206 |
Topical application of fluoride varnish |
184 |
178 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
243 |
225 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
125 |
120 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
20 |
16 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
15 |
13 |
$409.50 |
| D9999 |
Unspecified adjunctive procedure, by report |
54 |
53 |
$0.00 |