| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,873 |
2,871 |
$123K |
| D0120 |
Periodic oral evaluation - established patient |
2,579 |
2,576 |
$61K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
857 |
503 |
$57K |
| D1206 |
Topical application of fluoride varnish |
1,742 |
1,738 |
$50K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,045 |
1,045 |
$26K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,100 |
1,011 |
$26K |
| D0272 |
Bitewings - two radiographic images |
1,263 |
1,261 |
$12K |
| D1351 |
Sealant - per tooth |
497 |
95 |
$10K |
| D0601 |
|
791 |
785 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
99 |
70 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
882 |
872 |
$4K |
| D0274 |
Bitewings - four radiographic images |
314 |
314 |
$4K |
| D0603 |
|
209 |
207 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
57 |
57 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
24 |
24 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
257 |
257 |
$744.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
14 |
12 |
$700.00 |
| D1330 |
|
850 |
831 |
$0.00 |
| D1310 |
|
349 |
347 |
$0.00 |