| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,992 |
1,905 |
$78K |
| D0272 |
Bitewings - two radiographic images |
1,840 |
1,754 |
$60K |
| D0120 |
Periodic oral evaluation - established patient |
2,033 |
1,967 |
$60K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,294 |
2,209 |
$49K |
| D7140 |
Extraction, erupted tooth or exposed root |
257 |
136 |
$24K |
| D1110 |
Prophylaxis - adult |
256 |
253 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
206 |
196 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
355 |
332 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
161 |
154 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
39 |
26 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
40 |
39 |
$2K |
| D1206 |
Topical application of fluoride varnish |
57 |
53 |
$1K |