| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1206 |
Topical application of fluoride varnish |
6,179 |
5,936 |
$116K |
| D1120 |
Prophylaxis - child |
4,035 |
3,876 |
$113K |
| D0120 |
Periodic oral evaluation - established patient |
5,514 |
5,295 |
$104K |
| D1110 |
Prophylaxis - adult |
2,056 |
1,965 |
$82K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,731 |
1,458 |
$44K |
| D0272 |
Bitewings - two radiographic images |
2,107 |
2,007 |
$43K |
| D0330 |
Panoramic radiographic image |
722 |
690 |
$38K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
616 |
363 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
428 |
412 |
$13K |
| D1351 |
Sealant - per tooth |
739 |
158 |
$13K |
| D0240 |
|
730 |
313 |
$9K |
| D0274 |
Bitewings - four radiographic images |
268 |
265 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
163 |
118 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
61 |
54 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
153 |
131 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
21 |
14 |
$1K |