| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,777 |
2,542 |
$72K |
| D0120 |
Periodic oral evaluation - established patient |
2,519 |
2,334 |
$63K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
524 |
317 |
$56K |
| D1206 |
Topical application of fluoride varnish |
3,219 |
2,951 |
$49K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
760 |
677 |
$34K |
| D0220 |
Intraoral - periapical first radiographic image |
1,923 |
1,744 |
$27K |
| D1351 |
Sealant - per tooth |
934 |
292 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
642 |
554 |
$26K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,092 |
1,553 |
$24K |
| D0272 |
Bitewings - two radiographic images |
1,345 |
1,222 |
$20K |
| D0330 |
Panoramic radiographic image |
275 |
223 |
$13K |
| D1110 |
Prophylaxis - adult |
359 |
322 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
47 |
24 |
$3K |
| D0274 |
Bitewings - four radiographic images |
68 |
61 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
20 |
13 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
25 |
25 |
$960.75 |