| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
4,327 |
3,953 |
$122K |
| D0120 |
Periodic oral evaluation - established patient |
5,973 |
5,434 |
$116K |
| D1206 |
Topical application of fluoride varnish |
5,082 |
4,628 |
$104K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,490 |
666 |
$98K |
| D1110 |
Prophylaxis - adult |
2,190 |
1,989 |
$91K |
| D1351 |
Sealant - per tooth |
3,460 |
878 |
$86K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,009 |
474 |
$51K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,007 |
1,724 |
$49K |
| D0272 |
Bitewings - two radiographic images |
1,609 |
1,476 |
$34K |
| D0220 |
Intraoral - periapical first radiographic image |
2,467 |
2,231 |
$27K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,144 |
1,858 |
$21K |
| D0274 |
Bitewings - four radiographic images |
572 |
526 |
$18K |
| D0330 |
Panoramic radiographic image |
308 |
294 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,209 |
1,083 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
140 |
77 |
$9K |
| D0240 |
|
419 |
192 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
45 |
41 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
84 |
74 |
$1K |
| D1999 |
|
24 |
24 |
$60.00 |