| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,645 |
2,614 |
$62K |
| D1120 |
Prophylaxis - child |
1,710 |
1,683 |
$56K |
| D1206 |
Topical application of fluoride varnish |
2,485 |
2,453 |
$51K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,649 |
1,497 |
$47K |
| D1110 |
Prophylaxis - adult |
1,093 |
1,082 |
$44K |
| D7140 |
Extraction, erupted tooth or exposed root |
549 |
194 |
$33K |
| D0272 |
Bitewings - two radiographic images |
1,847 |
1,812 |
$31K |
| D0330 |
Panoramic radiographic image |
538 |
534 |
$24K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
178 |
129 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
194 |
194 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
97 |
97 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
268 |
251 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
28 |
25 |
$2K |