| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
8,161 |
6,242 |
$165K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,945 |
2,911 |
$121K |
| D1206 |
Topical application of fluoride varnish |
4,605 |
4,183 |
$100K |
| D0330 |
Panoramic radiographic image |
1,600 |
1,466 |
$65K |
| D0120 |
Periodic oral evaluation - established patient |
5,312 |
3,105 |
$61K |
| D1351 |
Sealant - per tooth |
2,088 |
288 |
$56K |
| D0272 |
Bitewings - two radiographic images |
4,429 |
3,084 |
$52K |
| D0274 |
Bitewings - four radiographic images |
2,143 |
1,613 |
$40K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
327 |
229 |
$37K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
820 |
815 |
$29K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,740 |
2,112 |
$26K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
223 |
164 |
$19K |
| D7140 |
Extraction, erupted tooth or exposed root |
146 |
100 |
$12K |
| D0210 |
Intraoral - complete series of radiographic images |
170 |
170 |
$11K |
| D0145 |
Oral evaluation for a patient under three years of age |
201 |
201 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
73 |
72 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
204 |
203 |
$3K |
| D1110 |
Prophylaxis - adult |
154 |
28 |
$0.00 |
| D0603 |
|
3,009 |
1,676 |
$0.00 |