| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,502 |
2,894 |
$82K |
| D1110 |
Prophylaxis - adult |
1,475 |
1,248 |
$74K |
| D1120 |
Prophylaxis - child |
1,863 |
1,528 |
$63K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,018 |
2,497 |
$58K |
| D0272 |
Bitewings - two radiographic images |
1,604 |
1,325 |
$35K |
| D0330 |
Panoramic radiographic image |
477 |
403 |
$25K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
189 |
130 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
473 |
417 |
$16K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
63 |
40 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
119 |
102 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
89 |
71 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
40 |
25 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
17 |
12 |
$280.50 |