| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,462 |
1,462 |
$46K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
879 |
879 |
$30K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,523 |
1,523 |
$27K |
| D0272 |
Bitewings - two radiographic images |
1,200 |
1,200 |
$24K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
279 |
191 |
$20K |
| D0120 |
Periodic oral evaluation - established patient |
705 |
704 |
$16K |
| D0240 |
|
1,171 |
664 |
$15K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
546 |
498 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
935 |
931 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
156 |
116 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
818 |
806 |
$7K |
| D0274 |
Bitewings - four radiographic images |
62 |
61 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
16 |
12 |
$1K |
| D1110 |
Prophylaxis - adult |
15 |
15 |
$705.96 |
| D1206 |
Topical application of fluoride varnish |
29 |
29 |
$0.00 |