| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,806 |
1,693 |
$71K |
| D0120 |
Periodic oral evaluation - established patient |
2,387 |
2,250 |
$64K |
| D1206 |
Topical application of fluoride varnish |
2,600 |
2,453 |
$61K |
| D1110 |
Prophylaxis - adult |
947 |
911 |
$52K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
394 |
265 |
$44K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
332 |
232 |
$29K |
| D7140 |
Extraction, erupted tooth or exposed root |
138 |
69 |
$14K |
| D0330 |
Panoramic radiographic image |
310 |
295 |
$12K |
| D0272 |
Bitewings - two radiographic images |
785 |
750 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
216 |
213 |
$11K |
| D0274 |
Bitewings - four radiographic images |
150 |
150 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
43 |
39 |
$774.00 |
| D0220 |
Intraoral - periapical first radiographic image |
46 |
42 |
$372.00 |
| D9910 |
|
29 |
29 |
$290.00 |