| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,061 |
1,049 |
$27K |
| D1206 |
Topical application of fluoride varnish |
1,300 |
1,284 |
$20K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
214 |
152 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
387 |
382 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
831 |
830 |
$11K |
| D0272 |
Bitewings - two radiographic images |
243 |
243 |
$4K |
| D1110 |
Prophylaxis - adult |
77 |
77 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
42 |
39 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
20 |
13 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
15 |
13 |
$1K |
| D0274 |
Bitewings - four radiographic images |
25 |
25 |
$690.00 |
| D0140 |
Limited oral evaluation - problem focused |
26 |
26 |
$620.75 |
| D0220 |
Intraoral - periapical first radiographic image |
19 |
19 |
$201.24 |