| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,558 |
1,542 |
$57K |
| D7140 |
Extraction, erupted tooth or exposed root |
499 |
274 |
$54K |
| D0120 |
Periodic oral evaluation - established patient |
1,368 |
1,350 |
$44K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,118 |
1,103 |
$31K |
| D1351 |
Sealant - per tooth |
542 |
205 |
$22K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
219 |
161 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
375 |
372 |
$19K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
581 |
558 |
$16K |
| D1206 |
Topical application of fluoride varnish |
522 |
518 |
$15K |
| D0272 |
Bitewings - two radiographic images |
776 |
763 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
138 |
100 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
259 |
248 |
$11K |
| D1110 |
Prophylaxis - adult |
91 |
86 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
466 |
447 |
$4K |
| D0330 |
Panoramic radiographic image |
51 |
49 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
182 |
97 |
$2K |
| D0274 |
Bitewings - four radiographic images |
15 |
14 |
$422.64 |