| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,957 |
2,929 |
$106K |
| D0120 |
Periodic oral evaluation - established patient |
3,550 |
3,504 |
$88K |
| D1206 |
Topical application of fluoride varnish |
4,057 |
4,001 |
$82K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
570 |
278 |
$72K |
| D1110 |
Prophylaxis - adult |
712 |
687 |
$32K |
| D0272 |
Bitewings - two radiographic images |
1,152 |
1,131 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
1,736 |
1,696 |
$22K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
665 |
608 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,500 |
1,469 |
$20K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
212 |
121 |
$20K |
| D1351 |
Sealant - per tooth |
347 |
110 |
$11K |
| D8660 |
|
71 |
59 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
220 |
218 |
$9K |
| D0340 |
|
65 |
53 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
28 |
12 |
$3K |
| D0274 |
Bitewings - four radiographic images |
90 |
90 |
$3K |
| D0350 |
|
83 |
71 |
$3K |
| D8670 |
Periodic orthodontic treatment visit |
12 |
12 |
$2K |
| D0330 |
Panoramic radiographic image |
24 |
24 |
$1K |