| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,611 |
2,510 |
$103K |
| D0120 |
Periodic oral evaluation - established patient |
1,823 |
1,752 |
$47K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,494 |
1,429 |
$37K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
285 |
218 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
455 |
432 |
$9K |
| D1206 |
Topical application of fluoride varnish |
360 |
345 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
1,434 |
1,356 |
$8K |
| D1351 |
Sealant - per tooth |
64 |
34 |
$7K |
| D1110 |
Prophylaxis - adult |
294 |
272 |
$7K |
| D0274 |
Bitewings - four radiographic images |
375 |
350 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,164 |
1,098 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
208 |
199 |
$3K |
| D0272 |
Bitewings - two radiographic images |
324 |
302 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
33 |
28 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
32 |
28 |
$822.30 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
14 |
13 |
$524.45 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
21 |
20 |
$494.00 |