| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,283 |
4,194 |
$223K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
967 |
523 |
$202K |
| D0120 |
Periodic oral evaluation - established patient |
4,065 |
3,997 |
$164K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,078 |
4,973 |
$155K |
| D0272 |
Bitewings - two radiographic images |
3,205 |
3,156 |
$117K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,353 |
1,229 |
$93K |
| D1110 |
Prophylaxis - adult |
569 |
559 |
$41K |
| D7140 |
Extraction, erupted tooth or exposed root |
253 |
169 |
$38K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
182 |
131 |
$28K |
| D0330 |
Panoramic radiographic image |
316 |
308 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
325 |
297 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
305 |
291 |
$17K |
| D0274 |
Bitewings - four radiographic images |
145 |
145 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
279 |
272 |
$7K |
| D0601 |
|
3,273 |
3,196 |
$0.00 |
| D1330 |
|
187 |
176 |
$0.00 |
| D0603 |
|
772 |
756 |
$0.00 |
| D0602 |
|
549 |
542 |
$0.00 |