| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,206 |
4,138 |
$131K |
| D1206 |
Topical application of fluoride varnish |
5,405 |
5,297 |
$119K |
| D0120 |
Periodic oral evaluation - established patient |
4,855 |
4,731 |
$99K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
817 |
557 |
$69K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,074 |
1,849 |
$53K |
| D1110 |
Prophylaxis - adult |
1,271 |
1,235 |
$49K |
| D0272 |
Bitewings - two radiographic images |
1,465 |
1,408 |
$27K |
| D0330 |
Panoramic radiographic image |
379 |
367 |
$20K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
253 |
168 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
405 |
391 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
286 |
274 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
90 |
83 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
241 |
66 |
$2K |
| D0274 |
Bitewings - four radiographic images |
98 |
97 |
$2K |
| D1351 |
Sealant - per tooth |
92 |
37 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
23 |
13 |
$979.60 |
| D1999 |
|
41 |
38 |
$10.00 |