| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,705 |
2,485 |
$68K |
| D0120 |
Periodic oral evaluation - established patient |
3,123 |
2,862 |
$53K |
| D1999 |
|
2,835 |
2,361 |
$50K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,599 |
2,018 |
$47K |
| D0330 |
Panoramic radiographic image |
967 |
858 |
$40K |
| D1206 |
Topical application of fluoride varnish |
1,660 |
1,451 |
$33K |
| D0272 |
Bitewings - two radiographic images |
1,924 |
1,763 |
$31K |
| D1110 |
Prophylaxis - adult |
920 |
816 |
$28K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
373 |
224 |
$17K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
194 |
96 |
$12K |
| D0274 |
Bitewings - four radiographic images |
560 |
508 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
432 |
367 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
661 |
629 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
68 |
61 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
16 |
14 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
14 |
12 |
$896.00 |
| D1351 |
Sealant - per tooth |
35 |
12 |
$806.00 |