| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,383 |
2,155 |
$57K |
| D0120 |
Periodic oral evaluation - established patient |
3,450 |
3,148 |
$56K |
| D1110 |
Prophylaxis - adult |
1,490 |
1,352 |
$43K |
| D1999 |
|
2,373 |
2,084 |
$36K |
| D1206 |
Topical application of fluoride varnish |
1,519 |
1,399 |
$28K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,225 |
1,979 |
$26K |
| D0330 |
Panoramic radiographic image |
618 |
546 |
$23K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
263 |
120 |
$12K |
| D0272 |
Bitewings - two radiographic images |
753 |
675 |
$11K |
| D0274 |
Bitewings - four radiographic images |
605 |
538 |
$10K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
412 |
311 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
132 |
79 |
$6K |
| D1354 |
|
43 |
16 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
41 |
26 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
130 |
110 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
13 |
12 |
$348.00 |
| D1351 |
Sealant - per tooth |
43 |
12 |
$338.00 |