| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,220 |
1,192 |
$34K |
| D0120 |
Periodic oral evaluation - established patient |
1,084 |
1,058 |
$23K |
| D7140 |
Extraction, erupted tooth or exposed root |
255 |
145 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
951 |
925 |
$16K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
150 |
102 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
193 |
130 |
$10K |
| D0272 |
Bitewings - two radiographic images |
592 |
574 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
270 |
268 |
$8K |
| D1351 |
Sealant - per tooth |
340 |
129 |
$8K |
| D1206 |
Topical application of fluoride varnish |
401 |
399 |
$7K |
| D1110 |
Prophylaxis - adult |
170 |
166 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
203 |
188 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
526 |
477 |
$5K |
| D0330 |
Panoramic radiographic image |
86 |
86 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
317 |
204 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
12 |
12 |
$324.00 |