| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
1,080 |
969 |
$43K |
| D1206 |
Topical application of fluoride varnish |
1,046 |
939 |
$32K |
| D0120 |
Periodic oral evaluation - established patient |
931 |
832 |
$21K |
| D1351 |
Sealant - per tooth |
868 |
220 |
$16K |
| D0272 |
Bitewings - two radiographic images |
711 |
638 |
$11K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
216 |
93 |
$8K |
| D9248 |
|
70 |
60 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
354 |
280 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
79 |
44 |
$2K |
| D0274 |
Bitewings - four radiographic images |
90 |
77 |
$2K |
| D0330 |
Panoramic radiographic image |
45 |
42 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
36 |
26 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
37 |
32 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
16 |
16 |
$518.55 |
| D1353 |
|
86 |
40 |
$496.02 |
| D0220 |
Intraoral - periapical first radiographic image |
51 |
37 |
$405.56 |
| D0601 |
|
207 |
158 |
$119.00 |
| D0602 |
|
13 |
13 |
$8.00 |
| D9986 |
|
130 |
118 |
$0.00 |