| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,303 |
3,264 |
$89K |
| D1206 |
Topical application of fluoride varnish |
4,332 |
4,285 |
$70K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
739 |
377 |
$64K |
| D0120 |
Periodic oral evaluation - established patient |
3,811 |
3,770 |
$60K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
766 |
366 |
$52K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
911 |
862 |
$25K |
| D1110 |
Prophylaxis - adult |
544 |
539 |
$20K |
| D0272 |
Bitewings - two radiographic images |
1,095 |
1,082 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
2,137 |
2,101 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,971 |
1,904 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
124 |
123 |
$3K |
| D0274 |
Bitewings - four radiographic images |
74 |
74 |
$2K |
| D1351 |
Sealant - per tooth |
73 |
26 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
37 |
27 |
$0.00 |