| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
491 |
491 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
328 |
328 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
551 |
551 |
$10K |
| D0272 |
Bitewings - two radiographic images |
441 |
441 |
$9K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
207 |
191 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
218 |
218 |
$5K |
| D0240 |
|
394 |
223 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
61 |
38 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
180 |
179 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
26 |
19 |
$2K |
| D1351 |
Sealant - per tooth |
77 |
26 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
21 |
15 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
143 |
140 |
$1K |
| D0330 |
Panoramic radiographic image |
22 |
22 |
$1K |