| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,686 |
1,532 |
$57K |
| D1110 |
Prophylaxis - adult |
821 |
736 |
$37K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,031 |
433 |
$29K |
| D0330 |
Panoramic radiographic image |
119 |
107 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
375 |
342 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
240 |
111 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
106 |
67 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
63 |
53 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
636 |
503 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
151 |
135 |
$1K |
| D1351 |
Sealant - per tooth |
113 |
30 |
$621.12 |
| D1208 |
Topical application of fluoride, excluding varnish |
2,096 |
1,899 |
$412.31 |
| D1330 |
|
2,513 |
2,278 |
$362.90 |
| D0120 |
Periodic oral evaluation - established patient |
2,106 |
1,908 |
$362.75 |
| D0274 |
Bitewings - four radiographic images |
674 |
611 |
$101.52 |
| D0272 |
Bitewings - two radiographic images |
1,237 |
1,131 |
$90.64 |
| D0220 |
Intraoral - periapical first radiographic image |
355 |
319 |
$25.00 |
| D0601 |
|
1,531 |
1,389 |
$0.00 |
| D0602 |
|
826 |
754 |
$0.00 |
| D0603 |
|
33 |
32 |
$0.00 |
| D9986 |
|
518 |
484 |
$0.00 |