| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
2,881 |
2,879 |
$120K |
| D0120 |
Periodic oral evaluation - established patient |
2,333 |
2,331 |
$78K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,228 |
2,227 |
$59K |
| D1351 |
Sealant - per tooth |
1,302 |
303 |
$42K |
| D0272 |
Bitewings - two radiographic images |
977 |
977 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
905 |
887 |
$17K |
| D1206 |
Topical application of fluoride varnish |
466 |
466 |
$14K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
104 |
68 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
71 |
70 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
234 |
168 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
32 |
24 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
15 |
12 |
$2K |
| D0240 |
|
65 |
36 |
$1K |
| D9248 |
|
24 |
24 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
143 |
138 |
$0.00 |