| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,551 |
2,531 |
$81K |
| D1110 |
Prophylaxis - adult |
1,492 |
1,483 |
$80K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
750 |
493 |
$51K |
| D1206 |
Topical application of fluoride varnish |
1,462 |
1,449 |
$34K |
| D1120 |
Prophylaxis - child |
892 |
888 |
$29K |
| D0140 |
Limited oral evaluation - problem focused |
483 |
464 |
$15K |
| D0274 |
Bitewings - four radiographic images |
355 |
354 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
213 |
150 |
$9K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
396 |
333 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
57 |
42 |
$4K |
| D1354 |
|
38 |
15 |
$853.68 |
| D0272 |
Bitewings - two radiographic images |
52 |
52 |
$731.64 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12 |
12 |
$0.00 |