| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,587 |
4,495 |
$119K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,326 |
6,204 |
$102K |
| D0120 |
Periodic oral evaluation - established patient |
5,491 |
5,396 |
$85K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
629 |
368 |
$62K |
| D1110 |
Prophylaxis - adult |
1,484 |
1,459 |
$59K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,718 |
1,531 |
$52K |
| D0272 |
Bitewings - two radiographic images |
1,800 |
1,754 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
2,462 |
2,399 |
$22K |
| D9920 |
|
307 |
299 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,263 |
2,094 |
$20K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
164 |
99 |
$13K |
| D1351 |
Sealant - per tooth |
467 |
160 |
$13K |
| D0274 |
Bitewings - four radiographic images |
373 |
364 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
311 |
290 |
$9K |
| D0240 |
|
633 |
311 |
$8K |
| D0330 |
Panoramic radiographic image |
91 |
91 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
57 |
33 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
40 |
39 |
$1K |