| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
780 |
733 |
$35K |
| D1206 |
Topical application of fluoride varnish |
742 |
699 |
$30K |
| D1351 |
Sealant - per tooth |
1,457 |
297 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
470 |
448 |
$13K |
| D0274 |
Bitewings - four radiographic images |
602 |
565 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
183 |
99 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,340 |
760 |
$7K |
| D0120 |
Periodic oral evaluation - established patient |
309 |
290 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
323 |
260 |
$4K |
| D0330 |
Panoramic radiographic image |
114 |
111 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
354 |
332 |
$3K |
| D1353 |
|
131 |
28 |
$2K |
| D0272 |
Bitewings - two radiographic images |
81 |
78 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
51 |
40 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
46 |
19 |
$615.00 |
| D0140 |
Limited oral evaluation - problem focused |
17 |
13 |
$432.12 |
| D1208 |
Topical application of fluoride, excluding varnish |
39 |
35 |
$337.92 |