| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,949 |
1,905 |
$57K |
| D0120 |
Periodic oral evaluation - established patient |
2,351 |
2,302 |
$48K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
417 |
232 |
$42K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,644 |
2,607 |
$39K |
| D1110 |
Prophylaxis - adult |
656 |
656 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
1,342 |
1,303 |
$20K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
718 |
666 |
$19K |
| D0330 |
Panoramic radiographic image |
327 |
327 |
$15K |
| D0272 |
Bitewings - two radiographic images |
711 |
711 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
273 |
269 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
917 |
770 |
$7K |
| D0274 |
Bitewings - four radiographic images |
218 |
218 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
129 |
129 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
51 |
38 |
$3K |
| D1320 |
|
74 |
74 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
26 |
13 |
$2K |
| D1206 |
Topical application of fluoride varnish |
57 |
45 |
$1K |