| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
7,105 |
6,832 |
$284K |
| D0120 |
Periodic oral evaluation - established patient |
5,688 |
5,497 |
$152K |
| D1351 |
Sealant - per tooth |
2,675 |
1,233 |
$149K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,098 |
1,447 |
$130K |
| D1206 |
Topical application of fluoride varnish |
4,868 |
4,677 |
$127K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,795 |
2,608 |
$61K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,134 |
2,051 |
$50K |
| D0274 |
Bitewings - four radiographic images |
2,894 |
2,733 |
$44K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,035 |
817 |
$41K |
| D0220 |
Intraoral - periapical first radiographic image |
5,691 |
5,402 |
$32K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,710 |
4,954 |
$30K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
544 |
466 |
$28K |
| D7140 |
Extraction, erupted tooth or exposed root |
403 |
285 |
$22K |
| D0210 |
Intraoral - complete series of radiographic images |
476 |
439 |
$12K |
| D0272 |
Bitewings - two radiographic images |
1,252 |
1,198 |
$12K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
145 |
119 |
$11K |
| D1110 |
Prophylaxis - adult |
280 |
243 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
291 |
275 |
$5K |
| D4341 |
|
16 |
12 |
$4K |
| D0330 |
Panoramic radiographic image |
60 |
55 |
$1K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
15 |
12 |
$803.60 |
| D1999 |
|
492 |
403 |
$0.00 |