| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,478 |
3,191 |
$87K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,721 |
1,475 |
$74K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,504 |
1,386 |
$63K |
| D0120 |
Periodic oral evaluation - established patient |
2,286 |
2,098 |
$55K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
665 |
439 |
$50K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
493 |
293 |
$47K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,018 |
2,741 |
$46K |
| D0240 |
|
2,281 |
1,041 |
$33K |
| D1351 |
Sealant - per tooth |
934 |
219 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
1,515 |
1,368 |
$21K |
| D0272 |
Bitewings - two radiographic images |
1,228 |
1,113 |
$20K |
| D1110 |
Prophylaxis - adult |
442 |
396 |
$15K |
| D1206 |
Topical application of fluoride varnish |
924 |
865 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
589 |
332 |
$7K |
| D0170 |
|
195 |
181 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
94 |
56 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
120 |
117 |
$4K |
| D0274 |
Bitewings - four radiographic images |
138 |
125 |
$4K |
| D0145 |
Oral evaluation for a patient under three years of age |
159 |
112 |
$3K |
| D1354 |
|
372 |
90 |
$2K |
| D0330 |
Panoramic radiographic image |
26 |
26 |
$1K |
| D1330 |
|
58 |
58 |
$0.00 |
| D1310 |
|
57 |
57 |
$0.00 |