| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,609 |
1,597 |
$59K |
| D0120 |
Periodic oral evaluation - established patient |
1,196 |
1,193 |
$31K |
| D1206 |
Topical application of fluoride varnish |
1,430 |
1,414 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
274 |
269 |
$9K |
| D0272 |
Bitewings - two radiographic images |
498 |
490 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
165 |
153 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
197 |
197 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
102 |
101 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
36 |
14 |
$3K |
| D1330 |
|
1,098 |
1,096 |
$3K |
| D0240 |
|
198 |
102 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
23 |
13 |
$2K |
| D1351 |
Sealant - per tooth |
44 |
14 |
$2K |
| D0603 |
|
125 |
124 |
$1K |
| D1354 |
|
133 |
74 |
$1K |
| D1999 |
|
273 |
262 |
$772.58 |
| D0220 |
Intraoral - periapical first radiographic image |
60 |
55 |
$685.00 |