| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,724 |
2,178 |
$57K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
438 |
257 |
$50K |
| D0120 |
Periodic oral evaluation - established patient |
2,180 |
1,761 |
$41K |
| D1206 |
Topical application of fluoride varnish |
1,578 |
1,458 |
$34K |
| D0330 |
Panoramic radiographic image |
509 |
469 |
$24K |
| D0272 |
Bitewings - two radiographic images |
1,176 |
934 |
$17K |
| D1351 |
Sealant - per tooth |
536 |
78 |
$14K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
359 |
345 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,018 |
724 |
$10K |
| D0274 |
Bitewings - four radiographic images |
321 |
303 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
296 |
251 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
142 |
141 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
348 |
336 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
52 |
27 |
$4K |
| D0145 |
Oral evaluation for a patient under three years of age |
83 |
77 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
196 |
177 |
$2K |
| D0603 |
|
3,128 |
2,474 |
$0.00 |