| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,564 |
1,561 |
$77K |
| D0120 |
Periodic oral evaluation - established patient |
1,300 |
1,297 |
$43K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,812 |
1,809 |
$39K |
| D0272 |
Bitewings - two radiographic images |
1,028 |
1,026 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
2,217 |
1,897 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,163 |
1,776 |
$23K |
| D1110 |
Prophylaxis - adult |
342 |
342 |
$22K |
| D0330 |
Panoramic radiographic image |
242 |
241 |
$20K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
304 |
286 |
$19K |
| D9920 |
|
345 |
345 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
361 |
361 |
$17K |
| D1351 |
Sealant - per tooth |
328 |
98 |
$14K |
| D0274 |
Bitewings - four radiographic images |
244 |
244 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
190 |
188 |
$9K |
| D1330 |
|
1,641 |
1,639 |
$8K |
| D0145 |
Oral evaluation for a patient under three years of age |
140 |
140 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
28 |
24 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
29 |
12 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
13 |
$2K |
| D0602 |
|
214 |
214 |
$1K |
| D0603 |
|
38 |
38 |
$190.76 |