| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,354 |
4,314 |
$162K |
| D0120 |
Periodic oral evaluation - established patient |
4,761 |
4,673 |
$137K |
| D1110 |
Prophylaxis - adult |
2,284 |
2,176 |
$111K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,310 |
539 |
$89K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,651 |
1,554 |
$75K |
| D1351 |
Sealant - per tooth |
2,352 |
863 |
$70K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,205 |
3,170 |
$68K |
| D1206 |
Topical application of fluoride varnish |
2,077 |
2,055 |
$53K |
| D0272 |
Bitewings - two radiographic images |
1,694 |
1,668 |
$38K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
374 |
207 |
$35K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
822 |
733 |
$31K |
| D0145 |
Oral evaluation for a patient under three years of age |
385 |
380 |
$18K |
| D0330 |
Panoramic radiographic image |
279 |
265 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
142 |
135 |
$7K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
14 |
12 |
$1K |
| D0274 |
Bitewings - four radiographic images |
16 |
13 |
$366.90 |
| D0220 |
Intraoral - periapical first radiographic image |
14 |
12 |
$142.52 |