| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,553 |
1,460 |
$39K |
| D1206 |
Topical application of fluoride varnish |
1,699 |
1,583 |
$37K |
| D0120 |
Periodic oral evaluation - established patient |
2,081 |
1,963 |
$36K |
| D1110 |
Prophylaxis - adult |
1,058 |
977 |
$35K |
| D0330 |
Panoramic radiographic image |
742 |
675 |
$28K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
230 |
158 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
552 |
495 |
$15K |
| D0272 |
Bitewings - two radiographic images |
1,323 |
1,246 |
$15K |
| D0274 |
Bitewings - four radiographic images |
1,049 |
970 |
$14K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
193 |
135 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
989 |
940 |
$13K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
375 |
347 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
471 |
428 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
54 |
24 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
59 |
51 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
262 |
85 |
$1K |
| D1999 |
|
289 |
247 |
$860.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
15 |
12 |
$0.00 |