| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
10,537 |
10,446 |
$342K |
| D0120 |
Periodic oral evaluation - established patient |
11,845 |
11,715 |
$218K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,281 |
1,686 |
$178K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,324 |
10,228 |
$175K |
| D1110 |
Prophylaxis - adult |
2,169 |
2,144 |
$110K |
| D0272 |
Bitewings - two radiographic images |
5,898 |
5,843 |
$86K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,106 |
917 |
$73K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,915 |
3,265 |
$66K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
809 |
803 |
$49K |
| D0220 |
Intraoral - periapical first radiographic image |
2,839 |
2,773 |
$26K |
| D0140 |
Limited oral evaluation - problem focused |
446 |
429 |
$25K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,562 |
1,544 |
$17K |
| D7140 |
Extraction, erupted tooth or exposed root |
142 |
113 |
$9K |
| D9310 |
|
14 |
14 |
$1K |
| D9430 |
|
14 |
13 |
$430.02 |
| D1999 |
|
24 |
21 |
$0.00 |