| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
6,330 |
6,135 |
$270K |
| D0120 |
Periodic oral evaluation - established patient |
5,218 |
5,070 |
$169K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,197 |
6,008 |
$167K |
| D1351 |
Sealant - per tooth |
2,237 |
976 |
$77K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
717 |
462 |
$69K |
| D0272 |
Bitewings - two radiographic images |
1,798 |
1,746 |
$54K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
860 |
832 |
$51K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
839 |
746 |
$46K |
| D0274 |
Bitewings - four radiographic images |
351 |
340 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
255 |
239 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
58 |
55 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
18 |
12 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
14 |
12 |
$986.86 |
| D0230 |
Intraoral - periapical each additional radiographic image |
21 |
12 |
$349.86 |
| D1999 |
|
19 |
19 |
$0.00 |