| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,249 |
1,240 |
$38K |
| D0120 |
Periodic oral evaluation - established patient |
1,296 |
1,287 |
$31K |
| D1206 |
Topical application of fluoride varnish |
997 |
990 |
$18K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
200 |
138 |
$11K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
261 |
231 |
$11K |
| D0272 |
Bitewings - two radiographic images |
520 |
514 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
411 |
409 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
213 |
211 |
$6K |
| D1110 |
Prophylaxis - adult |
155 |
153 |
$6K |
| D1330 |
|
594 |
592 |
$3K |
| D0603 |
|
260 |
260 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
26 |
12 |
$2K |
| D0602 |
|
153 |
153 |
$2K |
| D0330 |
Panoramic radiographic image |
27 |
25 |
$1K |
| D0601 |
|
100 |
100 |
$990.00 |
| D0240 |
|
30 |
28 |
$638.40 |