| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,853 |
1,511 |
$42K |
| D0120 |
Periodic oral evaluation - established patient |
1,783 |
1,402 |
$33K |
| D1206 |
Topical application of fluoride varnish |
1,168 |
1,011 |
$25K |
| D0330 |
Panoramic radiographic image |
459 |
408 |
$22K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
137 |
102 |
$16K |
| D0272 |
Bitewings - two radiographic images |
963 |
739 |
$14K |
| D7140 |
Extraction, erupted tooth or exposed root |
157 |
79 |
$12K |
| D0274 |
Bitewings - four radiographic images |
491 |
401 |
$12K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
260 |
236 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
744 |
560 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
86 |
69 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
35 |
28 |
$3K |
| D1351 |
Sealant - per tooth |
84 |
12 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
115 |
105 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
35 |
33 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
33 |
28 |
$1K |
| D0603 |
|
1,032 |
702 |
$0.00 |