| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,280 |
3,067 |
$85K |
| D0120 |
Periodic oral evaluation - established patient |
4,422 |
4,144 |
$75K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,105 |
753 |
$74K |
| D0272 |
Bitewings - two radiographic images |
2,629 |
2,467 |
$40K |
| D0330 |
Panoramic radiographic image |
879 |
828 |
$39K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,362 |
2,251 |
$33K |
| D1110 |
Prophylaxis - adult |
907 |
846 |
$29K |
| D1206 |
Topical application of fluoride varnish |
2,136 |
1,967 |
$28K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,241 |
1,070 |
$23K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
382 |
313 |
$19K |
| D0274 |
Bitewings - four radiographic images |
906 |
844 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
236 |
162 |
$10K |
| D1351 |
Sealant - per tooth |
309 |
94 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
76 |
72 |
$1K |
| D3120 |
|
16 |
12 |
$264.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
14 |
14 |
$264.00 |