| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
11,895 |
11,847 |
$615K |
| D1206 |
Topical application of fluoride varnish |
14,575 |
14,509 |
$382K |
| D0120 |
Periodic oral evaluation - established patient |
11,555 |
11,502 |
$339K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,436 |
903 |
$164K |
| D0272 |
Bitewings - two radiographic images |
3,770 |
3,755 |
$115K |
| D1351 |
Sealant - per tooth |
2,689 |
788 |
$108K |
| D1110 |
Prophylaxis - adult |
1,342 |
1,333 |
$92K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,692 |
1,480 |
$35K |
| D0274 |
Bitewings - four radiographic images |
771 |
764 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
535 |
534 |
$33K |
| D0220 |
Intraoral - periapical first radiographic image |
1,077 |
1,057 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
371 |
363 |
$17K |
| D7140 |
Extraction, erupted tooth or exposed root |
136 |
69 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
137 |
109 |
$12K |
| D0330 |
Panoramic radiographic image |
145 |
144 |
$11K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
90 |
48 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
297 |
224 |
$5K |
| D0145 |
Oral evaluation for a patient under three years of age |
95 |
95 |
$3K |
| D1330 |
|
76 |
75 |
$0.00 |