| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,338 |
3,298 |
$113K |
| D1110 |
Prophylaxis - adult |
1,007 |
998 |
$49K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
904 |
898 |
$31K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
292 |
151 |
$17K |
| D0120 |
Periodic oral evaluation - established patient |
3,373 |
3,335 |
$16K |
| D1206 |
Topical application of fluoride varnish |
3,992 |
3,952 |
$14K |
| D1330 |
|
3,019 |
2,988 |
$5K |
| D0330 |
Panoramic radiographic image |
56 |
55 |
$3K |
| D0272 |
Bitewings - two radiographic images |
1,871 |
1,850 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
356 |
334 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
45 |
26 |
$2K |
| D0274 |
Bitewings - four radiographic images |
461 |
457 |
$1K |
| D1351 |
Sealant - per tooth |
60 |
14 |
$580.66 |
| D0140 |
Limited oral evaluation - problem focused |
54 |
51 |
$549.28 |
| D1999 |
|
54 |
53 |
$245.27 |
| D0220 |
Intraoral - periapical first radiographic image |
55 |
54 |
$37.94 |
| D9986 |
|
272 |
264 |
$0.00 |
| D9987 |
|
20 |
18 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
62 |
61 |
$0.00 |