| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,984 |
1,779 |
$55K |
| D0330 |
Panoramic radiographic image |
725 |
641 |
$35K |
| D0140 |
Limited oral evaluation - problem focused |
808 |
712 |
$29K |
| D0120 |
Periodic oral evaluation - established patient |
1,042 |
927 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,333 |
1,184 |
$20K |
| D1206 |
Topical application of fluoride varnish |
621 |
576 |
$14K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
128 |
54 |
$11K |
| D0274 |
Bitewings - four radiographic images |
212 |
181 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
376 |
311 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
23 |
12 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
42 |
38 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
20 |
12 |
$2K |
| D0272 |
Bitewings - two radiographic images |
26 |
25 |
$609.05 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
228 |
156 |
$509.08 |
| D0230 |
Intraoral - periapical each additional radiographic image |
18 |
12 |
$125.40 |