| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
621 |
602 |
$41K |
| D1206 |
Topical application of fluoride varnish |
823 |
794 |
$34K |
| D0274 |
Bitewings - four radiographic images |
464 |
438 |
$31K |
| D0120 |
Periodic oral evaluation - established patient |
592 |
577 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
340 |
323 |
$28K |
| D1110 |
Prophylaxis - adult |
236 |
222 |
$22K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
99 |
52 |
$19K |
| D7140 |
Extraction, erupted tooth or exposed root |
101 |
54 |
$16K |
| D0272 |
Bitewings - two radiographic images |
322 |
317 |
$14K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
126 |
99 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
189 |
178 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
50 |
42 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
17 |
12 |
$3K |
| D0330 |
Panoramic radiographic image |
25 |
24 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
51 |
35 |
$2K |