| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,758 |
4,668 |
$142K |
| D1206 |
Topical application of fluoride varnish |
5,618 |
5,504 |
$102K |
| D0120 |
Periodic oral evaluation - established patient |
4,598 |
4,518 |
$82K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,609 |
1,506 |
$46K |
| D0272 |
Bitewings - two radiographic images |
1,020 |
990 |
$16K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
141 |
111 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
875 |
852 |
$9K |
| D9310 |
|
51 |
51 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
48 |
41 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
112 |
111 |
$3K |
| D1351 |
Sealant - per tooth |
103 |
40 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
39 |
29 |
$3K |
| D1110 |
Prophylaxis - adult |
82 |
82 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
114 |
98 |
$857.06 |
| D0274 |
Bitewings - four radiographic images |
12 |
12 |
$314.40 |