| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,821 |
4,521 |
$140K |
| D1351 |
Sealant - per tooth |
3,344 |
534 |
$89K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,665 |
1,610 |
$70K |
| D1206 |
Topical application of fluoride varnish |
2,845 |
2,744 |
$67K |
| D0120 |
Periodic oral evaluation - established patient |
2,335 |
2,216 |
$63K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,836 |
1,716 |
$31K |
| D0140 |
Limited oral evaluation - problem focused |
699 |
647 |
$30K |
| D0274 |
Bitewings - four radiographic images |
963 |
919 |
$27K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
287 |
129 |
$25K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
173 |
98 |
$20K |
| D0272 |
Bitewings - two radiographic images |
897 |
871 |
$19K |
| D0210 |
Intraoral - complete series of radiographic images |
253 |
245 |
$17K |
| D0330 |
Panoramic radiographic image |
219 |
208 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
122 |
71 |
$9K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
85 |
64 |
$896.72 |
| D0145 |
Oral evaluation for a patient under three years of age |
16 |
16 |
$615.21 |
| D0220 |
Intraoral - periapical first radiographic image |
25 |
25 |
$381.45 |
| D0350 |
|
13 |
13 |
$355.63 |