| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,166 |
3,050 |
$19K |
| D0120 |
Periodic oral evaluation - established patient |
2,768 |
2,673 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,499 |
3,372 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
448 |
185 |
$6K |
| D0272 |
Bitewings - two radiographic images |
1,567 |
1,498 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
2,659 |
2,531 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,673 |
2,302 |
$4K |
| D1351 |
Sealant - per tooth |
783 |
217 |
$2K |
| D0274 |
Bitewings - four radiographic images |
858 |
817 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
306 |
303 |
$2K |
| D0330 |
Panoramic radiographic image |
319 |
307 |
$761.50 |
| D7140 |
Extraction, erupted tooth or exposed root |
83 |
38 |
$676.73 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
225 |
191 |
$512.58 |
| D1110 |
Prophylaxis - adult |
158 |
151 |
$500.86 |
| D0145 |
Oral evaluation for a patient under three years of age |
96 |
91 |
$473.36 |
| D0140 |
Limited oral evaluation - problem focused |
48 |
42 |
$380.64 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
58 |
36 |
$332.66 |
| D9248 |
|
25 |
25 |
$224.78 |
| D1354 |
|
100 |
19 |
$174.20 |
| D3120 |
|
19 |
13 |
$27.86 |
| D0603 |
|
791 |
687 |
$0.00 |