| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
785 |
763 |
$18K |
| D1120 |
Prophylaxis - child |
558 |
546 |
$17K |
| D1110 |
Prophylaxis - adult |
341 |
331 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
224 |
158 |
$13K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
198 |
123 |
$13K |
| D1206 |
Topical application of fluoride varnish |
651 |
637 |
$12K |
| D0274 |
Bitewings - four radiographic images |
405 |
392 |
$10K |
| D0272 |
Bitewings - two radiographic images |
457 |
450 |
$8K |
| D0330 |
Panoramic radiographic image |
191 |
186 |
$8K |
| D1351 |
Sealant - per tooth |
252 |
82 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
230 |
196 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
216 |
209 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
132 |
130 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
38 |
26 |
$2K |
| D2331 |
|
21 |
13 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
118 |
113 |
$1K |