| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,162 |
2,109 |
$103K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
709 |
430 |
$74K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,433 |
2,367 |
$66K |
| D0120 |
Periodic oral evaluation - established patient |
2,337 |
2,271 |
$62K |
| D1110 |
Prophylaxis - adult |
385 |
370 |
$22K |
| D0272 |
Bitewings - two radiographic images |
791 |
759 |
$22K |
| D1351 |
Sealant - per tooth |
510 |
172 |
$20K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
875 |
774 |
$17K |
| D0274 |
Bitewings - four radiographic images |
350 |
335 |
$13K |
| D1354 |
|
1,020 |
401 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
142 |
104 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
78 |
76 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
245 |
227 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
103 |
96 |
$4K |
| D0330 |
Panoramic radiographic image |
27 |
27 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
22 |
14 |
$2K |