| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,199 |
1,110 |
$43K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
766 |
418 |
$41K |
| D1120 |
Prophylaxis - child |
1,220 |
1,150 |
$35K |
| D0120 |
Periodic oral evaluation - established patient |
1,563 |
1,474 |
$32K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
484 |
253 |
$29K |
| D0274 |
Bitewings - four radiographic images |
1,305 |
1,249 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
895 |
839 |
$23K |
| D0330 |
Panoramic radiographic image |
510 |
452 |
$14K |
| D1206 |
Topical application of fluoride varnish |
677 |
620 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
609 |
597 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
183 |
97 |
$8K |
| D0272 |
Bitewings - two radiographic images |
545 |
486 |
$7K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
59 |
27 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
68 |
67 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
102 |
96 |
$1K |
| D1351 |
Sealant - per tooth |
58 |
14 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
19 |
16 |
$521.50 |
| D1354 |
|
76 |
74 |
$425.59 |
| D1999 |
|
104 |
88 |
$0.00 |