| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,760 |
2,760 |
$91K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
676 |
388 |
$66K |
| D0120 |
Periodic oral evaluation - established patient |
2,577 |
2,577 |
$56K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,205 |
1,114 |
$37K |
| D1206 |
Topical application of fluoride varnish |
2,170 |
2,170 |
$34K |
| D0272 |
Bitewings - two radiographic images |
1,172 |
1,172 |
$21K |
| D1110 |
Prophylaxis - adult |
346 |
346 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
360 |
360 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
161 |
96 |
$12K |
| D1351 |
Sealant - per tooth |
403 |
148 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
427 |
421 |
$5K |
| D0274 |
Bitewings - four radiographic images |
166 |
166 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
44 |
24 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
282 |
198 |
$3K |
| D0330 |
Panoramic radiographic image |
39 |
39 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
44 |
44 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
64 |
64 |
$1K |