| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,875 |
3,875 |
$148K |
| D0120 |
Periodic oral evaluation - established patient |
3,654 |
3,654 |
$95K |
| D1206 |
Topical application of fluoride varnish |
2,026 |
2,026 |
$59K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
683 |
528 |
$52K |
| D1351 |
Sealant - per tooth |
954 |
522 |
$51K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
530 |
419 |
$31K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,168 |
2,168 |
$29K |
| D0272 |
Bitewings - two radiographic images |
1,807 |
1,805 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
517 |
517 |
$13K |
| D1110 |
Prophylaxis - adult |
251 |
251 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
693 |
685 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
109 |
93 |
$7K |
| D0240 |
|
224 |
164 |
$4K |
| D0330 |
Panoramic radiographic image |
107 |
107 |
$4K |
| D1354 |
|
81 |
59 |
$3K |
| D0274 |
Bitewings - four radiographic images |
94 |
94 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
27 |
27 |
$340.90 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
570 |
544 |
$0.00 |
| D1999 |
|
270 |
261 |
$0.00 |
| D1330 |
|
50 |
50 |
$0.00 |