| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1206 |
Topical application of fluoride varnish |
447 |
442 |
$30K |
| D7140 |
Extraction, erupted tooth or exposed root |
289 |
125 |
$23K |
| D1110 |
Prophylaxis - adult |
399 |
392 |
$20K |
| D0140 |
Limited oral evaluation - problem focused |
510 |
445 |
$14K |
| D0274 |
Bitewings - four radiographic images |
480 |
466 |
$13K |
| D0120 |
Periodic oral evaluation - established patient |
434 |
427 |
$10K |
| D1120 |
Prophylaxis - child |
101 |
99 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
69 |
42 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
276 |
268 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
182 |
139 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
32 |
13 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
289 |
276 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
85 |
78 |
$2K |
| D0330 |
Panoramic radiographic image |
28 |
27 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
16 |
12 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
118 |
38 |
$0.00 |