| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
16,474 |
16,186 |
$692K |
| D0120 |
Periodic oral evaluation - established patient |
14,830 |
14,558 |
$474K |
| D1208 |
Topical application of fluoride, excluding varnish |
15,312 |
15,012 |
$404K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,430 |
1,334 |
$240K |
| D0274 |
Bitewings - four radiographic images |
3,762 |
3,692 |
$164K |
| D0272 |
Bitewings - two radiographic images |
3,197 |
3,155 |
$96K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,551 |
1,380 |
$84K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
616 |
596 |
$37K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
200 |
147 |
$16K |
| D1351 |
Sealant - per tooth |
297 |
102 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
190 |
185 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
61 |
39 |
$8K |
| D0330 |
Panoramic radiographic image |
91 |
87 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
239 |
219 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
26 |
12 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
23 |
13 |
$3K |
| D1999 |
|
155 |
152 |
$0.00 |