| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,991 |
1,962 |
$67K |
| D0120 |
Periodic oral evaluation - established patient |
1,973 |
1,948 |
$44K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,808 |
1,774 |
$30K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
228 |
110 |
$23K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
701 |
632 |
$19K |
| D0272 |
Bitewings - two radiographic images |
905 |
890 |
$18K |
| D1206 |
Topical application of fluoride varnish |
569 |
568 |
$17K |
| D7140 |
Extraction, erupted tooth or exposed root |
186 |
95 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
297 |
289 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
549 |
528 |
$7K |
| D0330 |
Panoramic radiographic image |
97 |
95 |
$6K |
| D1110 |
Prophylaxis - adult |
41 |
41 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
56 |
55 |
$2K |
| D1351 |
Sealant - per tooth |
35 |
12 |
$918.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
12 |
12 |
$324.00 |
| D1999 |
|
529 |
471 |
$0.00 |