| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,091 |
1,950 |
$64K |
| D0120 |
Periodic oral evaluation - established patient |
2,965 |
2,709 |
$64K |
| D1110 |
Prophylaxis - adult |
1,684 |
1,518 |
$61K |
| D1206 |
Topical application of fluoride varnish |
2,211 |
2,052 |
$41K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,585 |
1,351 |
$40K |
| D0330 |
Panoramic radiographic image |
880 |
787 |
$36K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,257 |
1,137 |
$22K |
| D0272 |
Bitewings - two radiographic images |
1,500 |
1,378 |
$19K |
| D0274 |
Bitewings - four radiographic images |
839 |
751 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
623 |
555 |
$14K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
120 |
76 |
$9K |
| D1351 |
Sealant - per tooth |
174 |
56 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
65 |
37 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
39 |
37 |
$456.46 |