| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,731 |
1,669 |
$82K |
| D1206 |
Topical application of fluoride varnish |
2,302 |
2,228 |
$69K |
| D0120 |
Periodic oral evaluation - established patient |
1,605 |
1,559 |
$55K |
| D1110 |
Prophylaxis - adult |
693 |
679 |
$53K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
704 |
685 |
$40K |
| D0140 |
Limited oral evaluation - problem focused |
559 |
546 |
$36K |
| D0272 |
Bitewings - two radiographic images |
1,038 |
1,005 |
$36K |
| D0330 |
Panoramic radiographic image |
397 |
388 |
$35K |
| D7140 |
Extraction, erupted tooth or exposed root |
289 |
166 |
$30K |
| D0274 |
Bitewings - four radiographic images |
591 |
578 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
693 |
683 |
$15K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
97 |
71 |
$14K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
107 |
105 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
32 |
27 |
$4K |
| D0145 |
Oral evaluation for a patient under three years of age |
51 |
50 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
77 |
53 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$700.00 |