| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,191 |
2,044 |
$105K |
| D1206 |
Topical application of fluoride varnish |
2,399 |
2,238 |
$60K |
| D0120 |
Periodic oral evaluation - established patient |
2,171 |
2,022 |
$60K |
| D0272 |
Bitewings - two radiographic images |
767 |
717 |
$22K |
| D1351 |
Sealant - per tooth |
416 |
110 |
$17K |
| D7140 |
Extraction, erupted tooth or exposed root |
171 |
87 |
$16K |
| D1110 |
Prophylaxis - adult |
229 |
217 |
$15K |
| D0274 |
Bitewings - four radiographic images |
219 |
213 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
68 |
30 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
121 |
110 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
324 |
301 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
132 |
127 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
260 |
240 |
$4K |
| D0330 |
Panoramic radiographic image |
41 |
40 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
91 |
72 |
$1K |
| D1330 |
|
40 |
40 |
$0.00 |