| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
5,519 |
5,224 |
$148K |
| D0330 |
Panoramic radiographic image |
3,099 |
2,862 |
$133K |
| D1110 |
Prophylaxis - adult |
3,483 |
3,307 |
$124K |
| D0120 |
Periodic oral evaluation - established patient |
6,593 |
6,267 |
$120K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,852 |
1,018 |
$117K |
| D1206 |
Topical application of fluoride varnish |
5,450 |
5,177 |
$109K |
| D1999 |
|
5,102 |
4,517 |
$92K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,378 |
2,197 |
$61K |
| D0274 |
Bitewings - four radiographic images |
1,856 |
1,735 |
$39K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,782 |
2,614 |
$38K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
431 |
280 |
$33K |
| D0272 |
Bitewings - two radiographic images |
2,029 |
1,875 |
$33K |
| D9110 |
|
852 |
775 |
$32K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,371 |
1,153 |
$29K |
| D0140 |
Limited oral evaluation - problem focused |
763 |
709 |
$21K |
| D7140 |
Extraction, erupted tooth or exposed root |
158 |
83 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
353 |
281 |
$3K |