| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,100 |
4,005 |
$184K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,776 |
4,673 |
$118K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,377 |
5,244 |
$77K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,231 |
919 |
$59K |
| D1110 |
Prophylaxis - adult |
1,255 |
1,217 |
$54K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
634 |
487 |
$40K |
| D1351 |
Sealant - per tooth |
2,228 |
688 |
$39K |
| D0330 |
Panoramic radiographic image |
893 |
863 |
$32K |
| D0272 |
Bitewings - two radiographic images |
1,820 |
1,765 |
$30K |
| D0274 |
Bitewings - four radiographic images |
888 |
864 |
$23K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
443 |
412 |
$16K |
| D0120 |
Periodic oral evaluation - established patient |
612 |
593 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
408 |
400 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
1,082 |
1,042 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
190 |
129 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,145 |
558 |
$8K |
| D2330 |
|
17 |
12 |
$972.40 |
| D1999 |
|
82 |
73 |
$0.00 |