| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,199 |
1,078 |
$168K |
| D1120 |
Prophylaxis - child |
2,907 |
2,904 |
$114K |
| D0120 |
Periodic oral evaluation - established patient |
3,328 |
3,327 |
$90K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
894 |
571 |
$68K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,832 |
3,829 |
$52K |
| D1110 |
Prophylaxis - adult |
915 |
915 |
$49K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
711 |
493 |
$36K |
| D1351 |
Sealant - per tooth |
623 |
214 |
$22K |
| D0272 |
Bitewings - two radiographic images |
987 |
986 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
491 |
490 |
$14K |
| D0274 |
Bitewings - four radiographic images |
379 |
379 |
$13K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
144 |
101 |
$11K |
| D0330 |
Panoramic radiographic image |
194 |
194 |
$10K |
| D2140 |
|
111 |
82 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
49 |
42 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
35 |
35 |
$458.85 |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$197.60 |