| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
6,194 |
5,983 |
$185K |
| D0120 |
Periodic oral evaluation - established patient |
7,722 |
7,460 |
$154K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,492 |
8,186 |
$129K |
| D0272 |
Bitewings - two radiographic images |
7,335 |
7,081 |
$117K |
| D1999 |
|
3,705 |
3,338 |
$69K |
| D1110 |
Prophylaxis - adult |
1,651 |
1,612 |
$68K |
| D0330 |
Panoramic radiographic image |
858 |
834 |
$43K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,614 |
1,515 |
$39K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
489 |
465 |
$13K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
101 |
84 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
90 |
51 |
$5K |
| D1206 |
Topical application of fluoride varnish |
100 |
98 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
35 |
26 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
41 |
40 |
$466.15 |