| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,880 |
3,622 |
$92K |
| D1120 |
Prophylaxis - child |
3,492 |
3,284 |
$89K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,691 |
1,436 |
$71K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,407 |
4,129 |
$67K |
| D0272 |
Bitewings - two radiographic images |
1,538 |
1,442 |
$26K |
| D1110 |
Prophylaxis - adult |
750 |
681 |
$25K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
257 |
142 |
$25K |
| D1351 |
Sealant - per tooth |
808 |
131 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
371 |
363 |
$16K |
| D0330 |
Panoramic radiographic image |
193 |
186 |
$10K |
| D0274 |
Bitewings - four radiographic images |
115 |
114 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
55 |
53 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
23 |
16 |
$1K |