| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,395 |
7,206 |
$202K |
| D0120 |
Periodic oral evaluation - established patient |
5,928 |
5,804 |
$157K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,914 |
7,704 |
$133K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,237 |
2,069 |
$97K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
831 |
568 |
$86K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,409 |
1,361 |
$63K |
| D0272 |
Bitewings - two radiographic images |
1,731 |
1,678 |
$32K |
| D1351 |
Sealant - per tooth |
1,024 |
266 |
$29K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
290 |
205 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
1,572 |
1,485 |
$23K |
| D0140 |
Limited oral evaluation - problem focused |
599 |
578 |
$22K |
| D7140 |
Extraction, erupted tooth or exposed root |
179 |
111 |
$11K |
| D0240 |
|
599 |
325 |
$10K |
| D1110 |
Prophylaxis - adult |
244 |
229 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
308 |
102 |
$3K |
| D0274 |
Bitewings - four radiographic images |
37 |
37 |
$1K |
| D1206 |
Topical application of fluoride varnish |
15 |
15 |
$246.54 |
| D1310 |
|
224 |
212 |
$0.00 |
| D1330 |
|
227 |
215 |
$0.00 |