| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,140 |
1,139 |
$29K |
| D1110 |
Prophylaxis - adult |
484 |
484 |
$21K |
| D1120 |
Prophylaxis - child |
495 |
495 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
445 |
445 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
1,423 |
1,410 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
64 |
30 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
81 |
50 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
166 |
159 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,273 |
1,269 |
$4K |
| D0274 |
Bitewings - four radiographic images |
296 |
295 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
59 |
57 |
$2K |
| D0330 |
Panoramic radiographic image |
49 |
49 |
$2K |
| D1206 |
Topical application of fluoride varnish |
55 |
55 |
$2K |
| D0272 |
Bitewings - two radiographic images |
158 |
158 |
$2K |