| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,934 |
2,871 |
$80K |
| D1120 |
Prophylaxis - child |
2,591 |
2,540 |
$73K |
| D1206 |
Topical application of fluoride varnish |
3,664 |
3,573 |
$71K |
| D0272 |
Bitewings - two radiographic images |
677 |
666 |
$18K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
477 |
418 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
67 |
65 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
147 |
142 |
$3K |
| D1110 |
Prophylaxis - adult |
54 |
52 |
$2K |
| D1351 |
Sealant - per tooth |
116 |
38 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
30 |
12 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
46 |
25 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
23 |
12 |
$714.47 |
| D1999 |
|
975 |
874 |
$115.09 |