| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
5,435 |
5,238 |
$229K |
| D1206 |
Topical application of fluoride varnish |
6,246 |
6,030 |
$215K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,956 |
1,086 |
$150K |
| D0120 |
Periodic oral evaluation - established patient |
5,470 |
5,254 |
$112K |
| D1351 |
Sealant - per tooth |
2,000 |
587 |
$66K |
| D1110 |
Prophylaxis - adult |
847 |
847 |
$52K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
463 |
342 |
$49K |
| D7140 |
Extraction, erupted tooth or exposed root |
516 |
248 |
$44K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,458 |
1,337 |
$42K |
| D0272 |
Bitewings - two radiographic images |
1,718 |
1,702 |
$41K |
| D0274 |
Bitewings - four radiographic images |
862 |
850 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
603 |
597 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
1,110 |
1,044 |
$17K |
| D0240 |
|
275 |
267 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
188 |
174 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
235 |
234 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
17 |
17 |
$505.75 |