| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,227 |
2,193 |
$68K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,230 |
2,195 |
$39K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,092 |
1,078 |
$37K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
434 |
304 |
$27K |
| D0120 |
Periodic oral evaluation - established patient |
1,071 |
1,058 |
$23K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
836 |
764 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,814 |
761 |
$17K |
| D7140 |
Extraction, erupted tooth or exposed root |
231 |
132 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
1,071 |
1,038 |
$12K |
| D0272 |
Bitewings - two radiographic images |
538 |
535 |
$11K |
| D1351 |
Sealant - per tooth |
364 |
142 |
$8K |
| D0274 |
Bitewings - four radiographic images |
268 |
264 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
92 |
56 |
$5K |
| D0330 |
Panoramic radiographic image |
39 |
38 |
$2K |