| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,647 |
3,548 |
$110K |
| D0120 |
Periodic oral evaluation - established patient |
4,442 |
4,322 |
$91K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
717 |
467 |
$65K |
| D1206 |
Topical application of fluoride varnish |
1,581 |
1,564 |
$48K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,954 |
2,845 |
$41K |
| D0272 |
Bitewings - two radiographic images |
1,780 |
1,735 |
$34K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,377 |
1,207 |
$33K |
| D1110 |
Prophylaxis - adult |
707 |
688 |
$27K |
| D0330 |
Panoramic radiographic image |
446 |
433 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
854 |
817 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
253 |
252 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
104 |
74 |
$8K |
| D0274 |
Bitewings - four radiographic images |
177 |
169 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
142 |
72 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
14 |
12 |
$975.00 |
| D0140 |
Limited oral evaluation - problem focused |
28 |
27 |
$822.15 |