| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,965 |
1,812 |
$75K |
| D1206 |
Topical application of fluoride varnish |
1,939 |
1,790 |
$57K |
| D1351 |
Sealant - per tooth |
3,452 |
598 |
$54K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,229 |
552 |
$47K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
944 |
352 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
928 |
838 |
$24K |
| D7140 |
Extraction, erupted tooth or exposed root |
560 |
303 |
$19K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,159 |
868 |
$17K |
| D0272 |
Bitewings - two radiographic images |
1,137 |
1,034 |
$17K |
| D0120 |
Periodic oral evaluation - established patient |
1,061 |
983 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
1,810 |
1,663 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,992 |
1,617 |
$10K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
158 |
95 |
$8K |
| D0274 |
Bitewings - four radiographic images |
214 |
207 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
54 |
40 |
$1K |
| D3120 |
|
56 |
25 |
$0.00 |