| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,494 |
3,888 |
$116K |
| D1206 |
Topical application of fluoride varnish |
4,258 |
3,704 |
$88K |
| D0120 |
Periodic oral evaluation - established patient |
2,604 |
2,366 |
$67K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,184 |
869 |
$27K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
288 |
165 |
$27K |
| D0272 |
Bitewings - two radiographic images |
1,311 |
1,084 |
$21K |
| D0274 |
Bitewings - four radiographic images |
514 |
460 |
$13K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
518 |
408 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
90 |
62 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
444 |
374 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
87 |
70 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
40 |
13 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
25 |
25 |
$575.00 |
| D1999 |
|
254 |
237 |
$0.00 |