| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,839 |
3,766 |
$122K |
| D0120 |
Periodic oral evaluation - established patient |
4,282 |
4,193 |
$99K |
| D1206 |
Topical application of fluoride varnish |
4,632 |
4,535 |
$95K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
762 |
343 |
$53K |
| D1110 |
Prophylaxis - adult |
998 |
979 |
$41K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,083 |
1,001 |
$30K |
| D0272 |
Bitewings - two radiographic images |
1,664 |
1,626 |
$28K |
| D0330 |
Panoramic radiographic image |
181 |
173 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
266 |
260 |
$7K |
| D1351 |
Sealant - per tooth |
227 |
62 |
$7K |
| D0274 |
Bitewings - four radiographic images |
162 |
160 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
254 |
241 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
15 |
12 |
$874.06 |