| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,984 |
1,932 |
$70K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,868 |
2,793 |
$62K |
| D0120 |
Periodic oral evaluation - established patient |
2,639 |
2,572 |
$56K |
| D1110 |
Prophylaxis - adult |
880 |
858 |
$43K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
305 |
213 |
$24K |
| D7140 |
Extraction, erupted tooth or exposed root |
256 |
150 |
$18K |
| D0330 |
Panoramic radiographic image |
300 |
291 |
$17K |
| D0272 |
Bitewings - two radiographic images |
804 |
780 |
$17K |
| D1351 |
Sealant - per tooth |
339 |
108 |
$11K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
111 |
94 |
$10K |
| D0274 |
Bitewings - four radiographic images |
334 |
322 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
250 |
243 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
180 |
168 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
112 |
104 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
294 |
282 |
$3K |
| D0240 |
|
175 |
168 |
$2K |