| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,805 |
1,805 |
$77K |
| D0120 |
Periodic oral evaluation - established patient |
3,434 |
3,434 |
$68K |
| D1120 |
Prophylaxis - child |
2,138 |
2,138 |
$61K |
| D0140 |
Limited oral evaluation - problem focused |
1,099 |
1,097 |
$31K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,137 |
2,137 |
$30K |
| D0274 |
Bitewings - four radiographic images |
924 |
924 |
$26K |
| D0330 |
Panoramic radiographic image |
529 |
529 |
$24K |
| D1206 |
Topical application of fluoride varnish |
1,473 |
1,473 |
$21K |
| D0272 |
Bitewings - two radiographic images |
1,186 |
1,186 |
$20K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
586 |
506 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
760 |
748 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
277 |
277 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
42 |
27 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
47 |
24 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
14 |
12 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
18 |
13 |
$1K |