| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
10,009 |
10,009 |
$421K |
| D0120 |
Periodic oral evaluation - established patient |
10,469 |
10,465 |
$297K |
| D1206 |
Topical application of fluoride varnish |
4,636 |
4,635 |
$132K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,093 |
782 |
$99K |
| D0272 |
Bitewings - two radiographic images |
5,839 |
5,839 |
$96K |
| D1351 |
Sealant - per tooth |
1,120 |
681 |
$91K |
| D0220 |
Intraoral - periapical first radiographic image |
6,660 |
6,647 |
$89K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,137 |
6,135 |
$85K |
| D1110 |
Prophylaxis - adult |
1,045 |
1,045 |
$59K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,600 |
5,598 |
$43K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
400 |
314 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
735 |
735 |
$21K |
| D0330 |
Panoramic radiographic image |
264 |
264 |
$10K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
478 |
464 |
$10K |
| D0274 |
Bitewings - four radiographic images |
36 |
36 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
12 |
12 |
$720.00 |
| D0140 |
Limited oral evaluation - problem focused |
28 |
27 |
$378.00 |
| D1999 |
|
290 |
284 |
$0.00 |
| D9996 |
|
15 |
15 |
$0.00 |