| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2332 |
|
3,733 |
1,826 |
$595K |
| D1120 |
Prophylaxis - child |
9,093 |
9,040 |
$395K |
| D0120 |
Periodic oral evaluation - established patient |
7,951 |
7,917 |
$263K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,153 |
9,099 |
$250K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,620 |
850 |
$173K |
| D0272 |
Bitewings - two radiographic images |
2,662 |
2,650 |
$82K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,048 |
1,033 |
$65K |
| D7140 |
Extraction, erupted tooth or exposed root |
443 |
270 |
$48K |
| D1351 |
Sealant - per tooth |
1,106 |
418 |
$43K |
| D0140 |
Limited oral evaluation - problem focused |
625 |
617 |
$28K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
371 |
361 |
$21K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
227 |
127 |
$20K |
| D0330 |
Panoramic radiographic image |
243 |
240 |
$18K |
| D1354 |
|
820 |
270 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
534 |
531 |
$9K |
| D0274 |
Bitewings - four radiographic images |
231 |
230 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
32 |
25 |
$4K |
| D2394 |
|
15 |
13 |
$3K |
| D0603 |
|
12 |
12 |
$0.00 |
| D0602 |
|
12 |
12 |
$0.00 |
| D1999 |
|
55 |
52 |
$0.00 |
| D1110 |
Prophylaxis - adult |
43 |
43 |
$0.00 |