| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9450 |
|
10,075 |
7,240 |
$217K |
| D1120 |
Prophylaxis - child |
3,645 |
3,510 |
$173K |
| D1206 |
Topical application of fluoride varnish |
4,961 |
4,776 |
$121K |
| D0120 |
Periodic oral evaluation - established patient |
4,383 |
4,216 |
$118K |
| D1110 |
Prophylaxis - adult |
1,398 |
1,346 |
$89K |
| D1351 |
Sealant - per tooth |
2,302 |
642 |
$84K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
762 |
547 |
$82K |
| D7140 |
Extraction, erupted tooth or exposed root |
671 |
402 |
$60K |
| D0274 |
Bitewings - four radiographic images |
1,136 |
1,105 |
$46K |
| D0330 |
Panoramic radiographic image |
541 |
516 |
$44K |
| D0272 |
Bitewings - two radiographic images |
1,117 |
1,078 |
$31K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
861 |
758 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
320 |
301 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
686 |
655 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
124 |
107 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
171 |
160 |
$9K |
| D9110 |
|
95 |
87 |
$6K |
| D3120 |
|
65 |
45 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
14 |
13 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
56 |
52 |
$787.00 |
| D1330 |
|
259 |
258 |
$0.00 |