| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,830 |
3,830 |
$132K |
| D1206 |
Topical application of fluoride varnish |
3,985 |
3,985 |
$94K |
| D0120 |
Periodic oral evaluation - established patient |
3,203 |
3,203 |
$83K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
941 |
619 |
$50K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
818 |
818 |
$21K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,016 |
947 |
$20K |
| D0140 |
Limited oral evaluation - problem focused |
595 |
582 |
$20K |
| D9920 |
|
945 |
937 |
$19K |
| D0603 |
|
1,822 |
1,822 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
329 |
230 |
$14K |
| D0272 |
Bitewings - two radiographic images |
1,097 |
1,097 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
164 |
126 |
$7K |
| D0602 |
|
437 |
437 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
805 |
800 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
45 |
41 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
323 |
319 |
$3K |
| D1110 |
Prophylaxis - adult |
54 |
54 |
$2K |
| D0274 |
Bitewings - four radiographic images |
100 |
100 |
$1K |