| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,576 |
1,554 |
$60K |
| D0120 |
Periodic oral evaluation - established patient |
1,822 |
1,800 |
$46K |
| D1206 |
Topical application of fluoride varnish |
1,642 |
1,605 |
$38K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
423 |
404 |
$23K |
| D0274 |
Bitewings - four radiographic images |
589 |
587 |
$19K |
| D1110 |
Prophylaxis - adult |
292 |
292 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
443 |
441 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
83 |
51 |
$6K |
| D0272 |
Bitewings - two radiographic images |
241 |
240 |
$5K |
| D0240 |
|
417 |
203 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
58 |
51 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
159 |
158 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
341 |
335 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
30 |
25 |
$2K |
| D1351 |
Sealant - per tooth |
43 |
12 |
$1K |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$518.25 |
| D0145 |
Oral evaluation for a patient under three years of age |
17 |
17 |
$393.00 |
| D1330 |
|
26 |
26 |
$260.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
40 |
28 |
$234.00 |