| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,742 |
2,703 |
$74K |
| D0120 |
Periodic oral evaluation - established patient |
4,047 |
3,997 |
$70K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
942 |
699 |
$67K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,443 |
3,392 |
$50K |
| D1351 |
Sealant - per tooth |
1,906 |
559 |
$47K |
| D1110 |
Prophylaxis - adult |
1,200 |
1,179 |
$40K |
| D0272 |
Bitewings - two radiographic images |
2,293 |
2,263 |
$36K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,393 |
1,242 |
$27K |
| D0274 |
Bitewings - four radiographic images |
1,223 |
1,199 |
$26K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
301 |
239 |
$16K |
| D7140 |
Extraction, erupted tooth or exposed root |
272 |
210 |
$14K |
| D1206 |
Topical application of fluoride varnish |
836 |
818 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
240 |
227 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
410 |
389 |
$4K |
| D0330 |
Panoramic radiographic image |
89 |
88 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
91 |
85 |
$2K |
| D2140 |
|
16 |
12 |
$768.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
12 |
12 |
$220.00 |