| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,354 |
7,349 |
$252K |
| D0120 |
Periodic oral evaluation - established patient |
9,370 |
9,363 |
$228K |
| D1206 |
Topical application of fluoride varnish |
9,667 |
9,655 |
$189K |
| D1110 |
Prophylaxis - adult |
3,044 |
3,042 |
$139K |
| D1351 |
Sealant - per tooth |
2,785 |
661 |
$95K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
679 |
356 |
$88K |
| D0272 |
Bitewings - two radiographic images |
3,633 |
3,630 |
$77K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,149 |
1,149 |
$46K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,013 |
979 |
$32K |
| D0274 |
Bitewings - four radiographic images |
839 |
839 |
$26K |
| D7140 |
Extraction, erupted tooth or exposed root |
252 |
121 |
$24K |
| D0330 |
Panoramic radiographic image |
366 |
366 |
$19K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
89 |
64 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
818 |
810 |
$10K |
| D0240 |
|
256 |
245 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
79 |
79 |
$3K |
| D3120 |
|
25 |
13 |
$924.50 |
| D0230 |
Intraoral - periapical each additional radiographic image |
12 |
12 |
$213.69 |