| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
921 |
866 |
$37K |
| D1206 |
Topical application of fluoride varnish |
914 |
859 |
$23K |
| D0120 |
Periodic oral evaluation - established patient |
660 |
629 |
$18K |
| D1351 |
Sealant - per tooth |
151 |
104 |
$14K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
183 |
161 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
284 |
257 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
168 |
149 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
112 |
102 |
$4K |
| D0330 |
Panoramic radiographic image |
212 |
205 |
$3K |
| D0274 |
Bitewings - four radiographic images |
239 |
220 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
55 |
45 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
119 |
101 |
$3K |
| D0272 |
Bitewings - two radiographic images |
210 |
193 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
328 |
302 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
243 |
222 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
59 |
57 |
$939.60 |
| D1999 |
|
14 |
13 |
$0.00 |