| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
6,615 |
6,517 |
$280K |
| D0120 |
Periodic oral evaluation - established patient |
7,784 |
7,676 |
$223K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,679 |
1,025 |
$201K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,244 |
8,125 |
$184K |
| D1110 |
Prophylaxis - adult |
1,629 |
1,610 |
$95K |
| D1351 |
Sealant - per tooth |
2,025 |
578 |
$68K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
533 |
322 |
$51K |
| D0272 |
Bitewings - two radiographic images |
2,947 |
2,899 |
$43K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,517 |
1,378 |
$27K |
| D1330 |
|
4,234 |
4,170 |
$25K |
| D7140 |
Extraction, erupted tooth or exposed root |
193 |
108 |
$20K |
| D0274 |
Bitewings - four radiographic images |
816 |
803 |
$17K |
| D0330 |
Panoramic radiographic image |
339 |
335 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
170 |
169 |
$9K |
| D1206 |
Topical application of fluoride varnish |
230 |
227 |
$5K |
| D9248 |
|
26 |
26 |
$5K |
| D0145 |
Oral evaluation for a patient under three years of age |
106 |
103 |
$4K |
| D0240 |
|
118 |
117 |
$2K |
| D3120 |
|
33 |
24 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
128 |
128 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
12 |
12 |
$518.40 |