| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,872 |
2,739 |
$121K |
| D1206 |
Topical application of fluoride varnish |
2,861 |
2,730 |
$99K |
| D0120 |
Periodic oral evaluation - established patient |
2,720 |
2,598 |
$56K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
418 |
316 |
$43K |
| D0272 |
Bitewings - two radiographic images |
1,025 |
973 |
$24K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
307 |
227 |
$23K |
| D1351 |
Sealant - per tooth |
694 |
203 |
$23K |
| D0330 |
Panoramic radiographic image |
243 |
242 |
$14K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
448 |
411 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
332 |
310 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
113 |
67 |
$9K |
| D0274 |
Bitewings - four radiographic images |
222 |
210 |
$7K |
| D0240 |
|
170 |
160 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
278 |
260 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
79 |
75 |
$3K |
| D1110 |
Prophylaxis - adult |
29 |
27 |
$2K |