| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,826 |
1,805 |
$55K |
| D0120 |
Periodic oral evaluation - established patient |
2,154 |
2,134 |
$51K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
601 |
532 |
$28K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,144 |
1,140 |
$24K |
| D1110 |
Prophylaxis - adult |
485 |
484 |
$20K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
221 |
193 |
$18K |
| D1206 |
Topical application of fluoride varnish |
802 |
793 |
$17K |
| D0272 |
Bitewings - two radiographic images |
835 |
828 |
$16K |
| D1330 |
|
1,532 |
1,513 |
$10K |
| D1310 |
|
1,533 |
1,514 |
$10K |
| D0274 |
Bitewings - four radiographic images |
300 |
299 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
100 |
94 |
$7K |
| D0602 |
|
655 |
651 |
$6K |
| D0603 |
|
437 |
425 |
$4K |
| D1351 |
Sealant - per tooth |
48 |
34 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
286 |
280 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
16 |
13 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
126 |
122 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
37 |
37 |
$946.38 |