| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,425 |
1,392 |
$40K |
| D0120 |
Periodic oral evaluation - established patient |
1,003 |
996 |
$27K |
| D1206 |
Topical application of fluoride varnish |
1,355 |
1,323 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
381 |
376 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
883 |
862 |
$14K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
199 |
176 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
768 |
740 |
$10K |
| D0272 |
Bitewings - two radiographic images |
508 |
497 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
93 |
31 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
63 |
27 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
269 |
266 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
53 |
20 |
$4K |
| D0330 |
Panoramic radiographic image |
49 |
49 |
$2K |
| D1351 |
Sealant - per tooth |
49 |
13 |
$1K |