| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,625 |
1,465 |
$43K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
248 |
92 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
843 |
748 |
$28K |
| D0330 |
Panoramic radiographic image |
558 |
523 |
$24K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
351 |
66 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,353 |
1,232 |
$21K |
| D0120 |
Periodic oral evaluation - established patient |
541 |
517 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
328 |
306 |
$12K |
| D0274 |
Bitewings - four radiographic images |
313 |
290 |
$8K |
| D0272 |
Bitewings - two radiographic images |
483 |
440 |
$8K |
| D0350 |
|
135 |
124 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
28 |
16 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
15 |
15 |
$994.80 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
158 |
134 |
$243.60 |
| D0220 |
Intraoral - periapical first radiographic image |
13 |
12 |
$171.06 |
| D1999 |
|
490 |
450 |
$0.00 |