| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
5,635 |
5,458 |
$242K |
| D0120 |
Periodic oral evaluation - established patient |
5,567 |
5,399 |
$181K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,841 |
1,295 |
$177K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,180 |
1,387 |
$176K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,706 |
5,510 |
$154K |
| D0272 |
Bitewings - two radiographic images |
2,081 |
2,016 |
$62K |
| D0140 |
Limited oral evaluation - problem focused |
668 |
621 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
386 |
360 |
$22K |
| D0330 |
Panoramic radiographic image |
245 |
240 |
$19K |
| D1351 |
Sealant - per tooth |
464 |
176 |
$17K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
45 |
40 |
$2K |
| D0274 |
Bitewings - four radiographic images |
13 |
13 |
$611.52 |
| D0220 |
Intraoral - periapical first radiographic image |
32 |
26 |
$471.58 |
| D1999 |
|
198 |
187 |
$0.00 |