| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
933 |
874 |
$25K |
| D0120 |
Periodic oral evaluation - established patient |
1,208 |
1,135 |
$25K |
| D1206 |
Topical application of fluoride varnish |
977 |
898 |
$19K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
400 |
356 |
$16K |
| D1110 |
Prophylaxis - adult |
388 |
367 |
$14K |
| D9920 |
|
102 |
91 |
$13K |
| D1351 |
Sealant - per tooth |
481 |
106 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
188 |
89 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
169 |
71 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
478 |
476 |
$8K |
| D1330 |
|
963 |
890 |
$7K |
| D0272 |
Bitewings - two radiographic images |
391 |
366 |
$6K |
| D1310 |
|
459 |
458 |
$5K |
| D0603 |
|
459 |
404 |
$5K |
| D0274 |
Bitewings - four radiographic images |
70 |
58 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
41 |
41 |
$799.00 |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$480.78 |
| D0601 |
|
23 |
12 |
$233.30 |
| D0140 |
Limited oral evaluation - problem focused |
15 |
14 |
$143.00 |
| D0220 |
Intraoral - periapical first radiographic image |
14 |
13 |
$124.92 |