| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,319 |
1,813 |
$85K |
| D0120 |
Periodic oral evaluation - established patient |
3,520 |
2,773 |
$61K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,305 |
1,806 |
$36K |
| D0274 |
Bitewings - four radiographic images |
1,213 |
961 |
$30K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
646 |
378 |
$27K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,240 |
972 |
$21K |
| D1120 |
Prophylaxis - child |
938 |
765 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
562 |
350 |
$17K |
| D0330 |
Panoramic radiographic image |
207 |
173 |
$7K |
| D1351 |
Sealant - per tooth |
300 |
76 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
209 |
147 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
74 |
38 |
$3K |
| D0272 |
Bitewings - two radiographic images |
128 |
115 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
33 |
26 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
14 |
12 |
$625.89 |