| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
916 |
804 |
$28K |
| D0120 |
Periodic oral evaluation - established patient |
994 |
863 |
$24K |
| D0145 |
Oral evaluation for a patient under three years of age |
165 |
162 |
$22K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
255 |
138 |
$18K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
217 |
136 |
$14K |
| D1206 |
Topical application of fluoride varnish |
1,083 |
947 |
$14K |
| D0272 |
Bitewings - two radiographic images |
566 |
488 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
1,062 |
917 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,081 |
866 |
$10K |
| D0274 |
Bitewings - four radiographic images |
262 |
226 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
326 |
286 |
$8K |
| D1110 |
Prophylaxis - adult |
156 |
135 |
$7K |
| D0330 |
Panoramic radiographic image |
43 |
40 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
51 |
44 |
$2K |
| D1351 |
Sealant - per tooth |
62 |
12 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
20 |
13 |
$960.90 |
| D0140 |
Limited oral evaluation - problem focused |
43 |
42 |
$732.42 |
| D0603 |
|
1,120 |
1,010 |
$0.00 |
| D0601 |
|
82 |
81 |
$0.00 |