| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
5,047 |
5,035 |
$115K |
| D0120 |
Periodic oral evaluation - established patient |
4,433 |
4,420 |
$112K |
| D1206 |
Topical application of fluoride varnish |
5,515 |
5,497 |
$101K |
| D9999 |
Unspecified adjunctive procedure, by report |
1,832 |
1,829 |
$52K |
| D1351 |
Sealant - per tooth |
2,343 |
699 |
$47K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
982 |
978 |
$38K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,752 |
1,619 |
$36K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
507 |
291 |
$34K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
549 |
314 |
$30K |
| D0272 |
Bitewings - two radiographic images |
1,874 |
1,870 |
$19K |
| D1999 |
|
869 |
787 |
$12K |
| D0330 |
Panoramic radiographic image |
250 |
250 |
$10K |
| D1110 |
Prophylaxis - adult |
74 |
73 |
$3K |
| D0274 |
Bitewings - four radiographic images |
146 |
146 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
20 |
13 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
33 |
33 |
$653.07 |
| D1208 |
Topical application of fluoride, excluding varnish |
15 |
15 |
$185.50 |