| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,013 |
986 |
$31K |
| D0120 |
Periodic oral evaluation - established patient |
939 |
916 |
$23K |
| D7140 |
Extraction, erupted tooth or exposed root |
234 |
124 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
761 |
747 |
$14K |
| D0272 |
Bitewings - two radiographic images |
546 |
524 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
240 |
233 |
$8K |
| D1351 |
Sealant - per tooth |
304 |
113 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
89 |
60 |
$7K |
| D1206 |
Topical application of fluoride varnish |
364 |
350 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
226 |
215 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
79 |
55 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
485 |
451 |
$5K |
| D1110 |
Prophylaxis - adult |
97 |
96 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
282 |
167 |
$2K |
| D0330 |
Panoramic radiographic image |
32 |
32 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
71 |
61 |
$2K |