| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,856 |
2,363 |
$66K |
| D0140 |
Limited oral evaluation - problem focused |
1,634 |
1,271 |
$45K |
| D0330 |
Panoramic radiographic image |
1,109 |
910 |
$41K |
| D0120 |
Periodic oral evaluation - established patient |
1,220 |
1,058 |
$28K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
372 |
147 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,025 |
831 |
$13K |
| D1206 |
Topical application of fluoride varnish |
538 |
454 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
470 |
349 |
$10K |
| D1351 |
Sealant - per tooth |
213 |
40 |
$6K |
| D0274 |
Bitewings - four radiographic images |
177 |
167 |
$5K |
| D8670 |
Periodic orthodontic treatment visit |
45 |
37 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
51 |
26 |
$4K |
| D0272 |
Bitewings - two radiographic images |
160 |
143 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
23 |
12 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
204 |
126 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
146 |
121 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
17 |
17 |
$1K |
| D0602 |
|
17 |
17 |
$0.00 |