| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
5,337 |
4,984 |
$138K |
| D0120 |
Periodic oral evaluation - established patient |
6,989 |
6,584 |
$121K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,188 |
802 |
$91K |
| D1206 |
Topical application of fluoride varnish |
3,317 |
3,137 |
$80K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,648 |
5,249 |
$76K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,107 |
691 |
$65K |
| D1999 |
|
3,168 |
2,853 |
$58K |
| D0330 |
Panoramic radiographic image |
1,204 |
1,119 |
$52K |
| D1110 |
Prophylaxis - adult |
1,525 |
1,447 |
$52K |
| D0272 |
Bitewings - two radiographic images |
2,801 |
2,605 |
$46K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,004 |
1,735 |
$40K |
| D0145 |
Oral evaluation for a patient under three years of age |
751 |
678 |
$16K |
| D1351 |
Sealant - per tooth |
625 |
171 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
533 |
483 |
$11K |
| D0274 |
Bitewings - four radiographic images |
492 |
462 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
218 |
196 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
55 |
39 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
57 |
51 |
$550.00 |
| D1354 |
|
26 |
12 |
$220.00 |