| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
591 |
578 |
$15K |
| D1120 |
Prophylaxis - child |
362 |
355 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
507 |
504 |
$10K |
| D1351 |
Sealant - per tooth |
114 |
60 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
168 |
154 |
$5K |
| D1110 |
Prophylaxis - adult |
126 |
126 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
52 |
46 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
42 |
35 |
$4K |
| D0330 |
Panoramic radiographic image |
97 |
95 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
90 |
87 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
30 |
26 |
$2K |
| D0272 |
Bitewings - two radiographic images |
61 |
57 |
$1K |