| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,310 |
1,310 |
$59K |
| D0120 |
Periodic oral evaluation - established patient |
2,300 |
2,300 |
$48K |
| D1206 |
Topical application of fluoride varnish |
2,613 |
2,612 |
$43K |
| D1120 |
Prophylaxis - child |
1,308 |
1,308 |
$39K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
314 |
97 |
$38K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
243 |
160 |
$32K |
| D0330 |
Panoramic radiographic image |
604 |
604 |
$29K |
| D0274 |
Bitewings - four radiographic images |
892 |
892 |
$27K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
563 |
563 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
550 |
550 |
$16K |
| D0272 |
Bitewings - two radiographic images |
673 |
673 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
68 |
32 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
418 |
415 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
50 |
44 |
$1K |