| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,248 |
2,248 |
$81K |
| D0120 |
Periodic oral evaluation - established patient |
2,519 |
2,519 |
$64K |
| D1206 |
Topical application of fluoride varnish |
2,073 |
2,073 |
$56K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
824 |
767 |
$40K |
| D1110 |
Prophylaxis - adult |
644 |
644 |
$29K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
270 |
187 |
$20K |
| D1351 |
Sealant - per tooth |
433 |
114 |
$15K |
| D0272 |
Bitewings - two radiographic images |
588 |
588 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
420 |
420 |
$6K |
| D0330 |
Panoramic radiographic image |
115 |
115 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
343 |
336 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
73 |
39 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
140 |
140 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
34 |
27 |
$3K |
| D0274 |
Bitewings - four radiographic images |
89 |
89 |
$3K |
| D2394 |
|
16 |
12 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
119 |
64 |
$1K |