| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,875 |
2,817 |
$122K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,043 |
4,913 |
$104K |
| D0120 |
Periodic oral evaluation - established patient |
4,342 |
4,223 |
$104K |
| D1120 |
Prophylaxis - child |
2,514 |
2,427 |
$82K |
| D0330 |
Panoramic radiographic image |
1,505 |
1,414 |
$62K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,194 |
1,014 |
$33K |
| D0274 |
Bitewings - four radiographic images |
1,045 |
1,015 |
$28K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
329 |
233 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
495 |
472 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
137 |
101 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
392 |
369 |
$8K |
| D1351 |
Sealant - per tooth |
112 |
27 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
166 |
150 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
27 |
12 |
$2K |
| D0272 |
Bitewings - two radiographic images |
54 |
52 |
$894.99 |
| D9110 |
|
15 |
14 |
$692.50 |
| D1999 |
|
27 |
25 |
$0.00 |