| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,230 |
2,085 |
$58K |
| D1206 |
Topical application of fluoride varnish |
2,931 |
2,696 |
$53K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
738 |
374 |
$51K |
| D0120 |
Periodic oral evaluation - established patient |
2,872 |
2,658 |
$50K |
| D1999 |
|
2,557 |
2,299 |
$47K |
| D1110 |
Prophylaxis - adult |
971 |
858 |
$31K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,598 |
1,340 |
$30K |
| D0272 |
Bitewings - two radiographic images |
962 |
893 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
483 |
440 |
$10K |
| D0274 |
Bitewings - four radiographic images |
338 |
305 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
408 |
400 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
50 |
30 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
17 |
12 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
22 |
12 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
13 |
12 |
$826.80 |