| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,033 |
1,033 |
$29K |
| D0120 |
Periodic oral evaluation - established patient |
1,268 |
1,268 |
$25K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,488 |
1,488 |
$21K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
170 |
61 |
$18K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
608 |
527 |
$15K |
| D1110 |
Prophylaxis - adult |
257 |
257 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
134 |
66 |
$9K |
| D0330 |
Panoramic radiographic image |
123 |
123 |
$6K |
| D0272 |
Bitewings - two radiographic images |
291 |
291 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
275 |
264 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
130 |
125 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
29 |
13 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
26 |
12 |
$2K |
| D0274 |
Bitewings - four radiographic images |
52 |
52 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
44 |
44 |
$1K |