| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,522 |
1,399 |
$59K |
| D7140 |
Extraction, erupted tooth or exposed root |
404 |
282 |
$29K |
| D0120 |
Periodic oral evaluation - established patient |
1,028 |
956 |
$28K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,021 |
940 |
$25K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
188 |
162 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
645 |
579 |
$13K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
266 |
259 |
$7K |
| D1206 |
Topical application of fluoride varnish |
149 |
137 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
223 |
195 |
$3K |
| D0272 |
Bitewings - two radiographic images |
285 |
256 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
61 |
58 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
281 |
220 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
428 |
384 |
$2K |
| D0274 |
Bitewings - four radiographic images |
198 |
182 |
$2K |
| D0330 |
Panoramic radiographic image |
96 |
91 |
$2K |
| D1354 |
|
351 |
295 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
19 |
12 |
$1K |
| D1351 |
Sealant - per tooth |
16 |
12 |
$1K |
| D9310 |
|
47 |
46 |
$786.60 |
| D0210 |
Intraoral - complete series of radiographic images |
44 |
41 |
$487.10 |