| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,503 |
2,362 |
$97K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,212 |
883 |
$70K |
| D0120 |
Periodic oral evaluation - established patient |
2,535 |
2,404 |
$67K |
| D1206 |
Topical application of fluoride varnish |
1,709 |
1,575 |
$41K |
| D1351 |
Sealant - per tooth |
467 |
281 |
$28K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
556 |
442 |
$21K |
| D7140 |
Extraction, erupted tooth or exposed root |
448 |
345 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
969 |
894 |
$19K |
| D1208 |
Topical application of fluoride, excluding varnish |
521 |
508 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
2,345 |
2,181 |
$12K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
500 |
412 |
$12K |
| D0272 |
Bitewings - two radiographic images |
1,103 |
1,026 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,941 |
1,790 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
486 |
450 |
$7K |
| D0274 |
Bitewings - four radiographic images |
451 |
427 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
260 |
244 |
$6K |
| D1110 |
Prophylaxis - adult |
230 |
210 |
$6K |
| D9110 |
|
106 |
102 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
81 |
62 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
28 |
24 |
$2K |
| D0270 |
|
26 |
26 |
$145.60 |
| D1330 |
|
42 |
42 |
$0.00 |